What exactly are exosomes and how we apply them in medical protocols
Exosomes are vesicles that form within cells in biological processes as a response to changes in the internal state of the cell—such as homeostasis, aging, inflammation, photo-damage, electromagnetic damage, and tissue regeneration. They have been studied in medicine for over 30 years.
Exosomes contain molecules such as proteins, membrane and lumen proteins, lipids, metabolites, RNA, DNA, MHC complexes, growth factors, heat shock proteins, and are considered signaling molecules. Through these, they transmit information between cells via biogenetic molecules, thereby relaying information to other cells both nearby and at distant locations.
Origin of Exosomes
Exosomes derived from plant or animal sources, or those obtained through engineering, are molecules that can only be used for cosmetic purposes, for local application. They should not be injected and do not have medical certifications.
Human exosomes in medical practice can only be used as autologous, meaning only autotransfer of exosomes is permitted during medical procedures. They are applied as injectable agents or as topical preparations, given that they are nano molecules. Due to the nature of the exosome molecules, any transfer of foreign material is prohibited. In Figure 1, a comparison between autologous human exosomes and heterologous exosomes is shown in a table.
Figure 1. Comparison of Characteristics of Autologous and Heterologous Exosomes
Studies have shown that exosomes secreted from stem cells are effective in transporting NK (natural killer) cells to T-helper cells and play a role in modulating excessive and uncoordinated immune responses. Exosomes can incorporate certain medications, making them useful as carriers that deliver drugs directly to the desired site of action. They can also be used as biomarkers.
Today, due to the innovative method of producing autologous exosomes from serum, tissue fluids, exudates, or platelet-rich plasma, they are widely applied across all branches of medicine. The production of exosomes is a safe and non-toxic method of autotransplantation, scientifically proven to be effective, and is entirely based on internal resources for human tissue regeneration and disease prevention.
This treatment has gained popularity in various medical fields: dermatology, plastic surgery, aesthetic medicine, trichology, ophthalmology, dentistry, orthopedics, urology, gynecology, physical and sports medicine.
To achieve the maximum concentration of growth factors and exosomes during the processing of the sample, it undergoes treatment in a special MCT device that applies a specific wavelength of laser light under controlled temperature changes over a certain period. The sample being processed is called an orthopedic biological material, which includes plasma derivatives such as PRP, PPP, PRGF, PURP, PA-PRP, PTBA-PRP, serum derivatives like Orthokine, Sanakine, Exokine, biopsy liquid material like Regenera, derivatives of adipose tissue such as SVF, stem cell derivatives like Cytori, Smart-M, and other products such as monocytes.
In the last decade, improving the performance quality of PRP samples depended solely on platelet concentration. MCT plasma is a technological step ahead of the classic PRP process, dramatically improving platelet performance and the quantity of secreted granules, resulting in better treatment outcomes.
The key characteristics of plasma processed by MCT technology, with the production of autologous exosomes, are shown in Table 1.
Table 1. Properties of Plasma Processed by MCT Technology and Tissue Effects
Exosome Action
The action of exosomes and growth factors is multifaceted, ultrastructural, and autocrine. Below are eight key mechanisms of action:
1.Anti-inflammatory
By regulating inflammatory proteins like TNF-alpha, IL-1beta, MMP, IL-4, IL-10, and TIMPs, exosomes reduce inflammation, which is a central event in many autoimmune, inflammatory, and degenerative conditions.
2.Antioxidant
Exosomal proteins such as peroxiredoxin reduce oxidative stress in cells, which is present in many diseases and plays a role in degenerative pathology associated with aging. Reducing oxidative stress improves cell function and survival.
3.Anti-apoptotic
By increasing the protein and RNA content in cells affected by degenerative processes, exosomes improve their cellular function and prevent apoptosis. Anti-apoptotic signals carried by exosomes help slow down, stop, and reverse tissue degeneration.
4.Anti-fibrotic
Exosomes optimize tissue remodeling in damaged skin and improve the content and ratio of collagen types I-III and the normal organization of collagen fibers. Reducing fibrosis after tissue damage improves scar formation and prevents hypertrophy.
5.Immunomodulatory
Through polarization of macrophages and T-cells toward a reduced inflammatory response and a more regulatory phenotype, exosomes modulate inflammation and excessive immune response.
6.Pro-angiogenic
By stimulating the function of endothelial cells, exosomes improve angiogenesis. Improving vascularization in damaged tissue increases cell survival and prevents tissue degeneration and functional damage.
7.Prosynthetic
By activating specific cells, such as fibroblasts, exosomes influence the formation of extracellular matrix and tissue restoration. Specific mRNA regenerates skin collagen and joint cartilage.
8.Epigenetic
Proteins like histone deacetylase in exosomes induce transcription of inactive DNA and influence the function of target cells without changing the genome. By altering DNA methylation patterns, reactivation of gene expression is possible.
Exosome Application Protocol
The preparation and application procedure for exosomes is shown in Table 2.
Table 2. Procedure for Preparation and Application of Exosomes
Timeline for the Application of Exosomes in Regenerative Procedures
The dynamics of applying growth factors and exosomes depend on the underlying cause of the disease. Table 3 presents the timeline for the application of growth factors and exosomes in regenerative procedures.
Table 3. Timeline of application of egosism in regenerative procedures
Contraindications for the application of this method are malignant diseases, acute stages of treatment of various diseases with cytostatics and immunosuppressants, hemophilia, alcoholism and other addictions, lack of compliance and non-acceptance of the procedure, and acute infectious diseases.
Tables 4 and 5 show indications in Estonian medicine and trichology
Table 4. Indications for the use of exosomes in aesthetic medicine
Table 5. Indications for the use of exosomes in trichology
Table 6 shows the recommended combinations of various aesthetic procedures with the application of growth factors and exosomes.
Table 6. Recommended combinations of various aesthetic treatments with the application of growth factors and exosomes
Indications for the application of growth factors and exosomes in gynecology and surgery are shown in tables 7 and 8.
Table 7. Indications for the use of growth factors and exosomes in gynecology
Table 8. Indications for the use of growth factors and exosomes in surgery
Exosomes are undoubtedly much more than a novelty in aesthetic medicine. Their significant application in treating skin pigmentation anomalies, atopic dermatitis, psoriasis, alopecia, autoimmune diseases such as morphea or discoid lupus, opens a new chapter for regenerative medicine treatments in chronic dermatoses. Given the effects exerted through processes of intense fibroblast regeneration and influence on pluripotent stem cells, exosomes also have significant applications in the treatment of moderate to severe forms of acne and in early scar prevention procedures following inflammation.
Author of the text: Jasmina Kozarev
Anyone interested in individual education can apply to the email: drkwest65@gmail.com
Results of procedures performed at the Dr. Kozarev clinic:
