Exosomes
01 February 2024
Is the future of dermatology in biotechnology? Judging from the development in the last few decades- polynucleotides, stem cells and growth factors; regeneration with bioactive compounds seems to be heralding a new era in this field. The idea behind these treatments- using cells and proteins to repair scars and signs of ageing in the skin using “natural” cells- have proven to be popular; with regenerative treatments such PRP (aka vampire facials) and stem cell treatments becoming popular in the media among celebrities like Kim Kardashian.
Related blogposts:
Vampire Facials and Platelet Rich Plasma (PRP)
Rejuran Healer: What You Should Know Before Getting It
Salmon DNA Skincare and Needleless Rejuran Healer
5 Beauty Industry Scandals & Controversies
Now, there’s a new ingredient in the field of dermatology and aesthetics that is fast becoming a hot topic: Exosomes. Already trending in searches, exosomes are a buzzword that’s predicted to be big in 2024 and beyond; with predictions that exosome treatments could overtake Botox and other collagen stimulating treatments in popularity. Here’s everything you need to know about exosomes in aesthetic dermatology in this review. Stay tuned for my next blogpost on exosomes in skincare; with a scrutiny on the evidence and data.
Exosomes are products secreted by cells, including stem cells and platelets, for communication between cells; repair of tissues and regulation of the immune system1-4. Exosomes are biologically active, and have the potential to initiate repair and regeneration in tissues2-4. This regenerative potential has exosomes has been explored in specialties such as orthopaedics for the treatment of degenerative conditions and osteoporosis5,6.In the field of dermatology, the therapeutic potential of exosomes in treating acne scars, wound healing and signs of ageing are also being explored2-4.
Structurally, exosomes are very tiny particles- nano size to be precise7. Exosomes are released by cells; and belong to a category of structures known as extracellular vesicles. As the name suggests, extracellular vesicles are sacs released by cells3. Depending on the size of the extracellular vesicles, they can be classified as exosomes, microvesicles and apoptotic bodies. Exosomes are the smallest of extracellular vesicles and range from 40 to 100nm8-10.
Exosomes contain biologically active molecules such as lipids, proteins, and nucleic acids2,3,11. These molecules in exosomes behave as signals between cells. As a result, exosomes can influence cellular processes such as growth, differentiation, migration, and cell death12. These outcomes depend on factors such as the exosome origin and site of release12.
Since the discovery of exosomes was first reported in 1983; interest and research in harnessing the potential of exosomes has grown tremendously. In the field of dermatology, interest in exosomes for therapy and aesthetic treatments has also increased in recent years. Judging from the profusion of exosome therapies and skincare products that have entered the market in the last 2 years, hype around exosomes for aesthetic treatments is very likely to grow.
Currently in Singapore and around the world, exosome treatments are being explored for the treatment of hair loss, acne scars, wrinkles, dark spots and skin rejuvenation. Some of the advertised benefits of exosome therapy include hair growth, reduced acne scars, lighten dark spots, reduced pore size, brighter and younger looking skin and reduced fine wrinkles.
Despite the hype and media buzz about exosomes, especially exosome treatments and skincare; the molecular biology of exosome signalling is not fully understood yet. Some of the commonly reported signalling pathways include the TGF-β (transforming growth factor beta) and Wnt/β-catenin pathways13-18. However, preliminary studies have found the following benefits of exosomes on the skin.
1. Improved wound healing
Based on animal and cell studies, exosomes accelerate tissue remodeling and other key steps in the recovery process19-21.
2. Building collagen in the skin
Similarly, exosomes have also been found to promote collagen regeneration for rejuvenation and reducing scar formation22-25.
3. Reducing inflammation
Exosomes have been explored in the treatment of inflammatory skin diseases. as exosomes have been found in some studies to reduce inflammatory markers and symptoms of atopic dermatitis and psoriasis26-28.
4. Modulate blood vessel growth
Various studies have shown that exosomes facilitate the formation of new blood vessels29-32. This process is also known as angiogenesis and is required for normal functioning of organs31.
5. Lightening hyperpigmentation
Early studies also suggest that exosomes can reduce dark spots by inhibiting the formation of melanin, the pigment that makes hyperpigmentation look dark33,31.
Related blogposts:
How to Lighten Dark Spots with Skin Care
Hyperpigmentation Disorders: Causes, Types, Treatments
Based on these findings, exosomes seem like an exciting and interesting therapeutic option for treating wounds, scars, inflammation and signs of ageing in the skin. However, research of exosomes is still in its very early stages. Can exosomes be directed to repair damage and signs of ageing in the skin without side effects? This question still remains unanswered. Additional studies are still required to better understand the safety and effectiveness for the application of medical aesthetics and dermatology.
Some other limitations and gaps in the understanding of exosome therapy in dermatology include:
• Lack of robust scientific data on exosomes
Currently, most of the published data and studies on exosomes are based on cell studies and animal studies. Currently, the existing research mainly focuses on the skin application of mouse- and human-derived exosomes, and the constituents of these exsosomes and genomes are still unclear. These findings may or may not translate into similar clinical findings due to differences in the specimens and conditions of these trials. Large, randomised clinical trials are needed to ascertain the benefits and side effects of exosomes in humans.
• Heterogeneity of studies
Besides the lack of large and rigorous clinical studies on exosomes, the heterogeneity in the current literature in terms of exosomes source, purity and method of delivery makes it hard to compare the results across the studies.
At present, exosomes used for medical aesthetics involve application topically or through means of injections or microneedle transdermal drug delivery systems35-38. However, there is no consensus on a standardised treatment for optimal outcomes; and the results of exosome therapy seem to differ depending on the source and method of administration39.
•Side effects and complications of exosome treatments
Is exosome therapy all rewards without risk? This question still lacks an answer; as reports of side effects from published studies are lacking. Since exosomes affect cell signalling to initiate cell changes, is it possible to distort these cell signalling mechanisms to result in unwanted side effects? An example is with Damage-associated molecular patterns (DAMPs). DAMPs are signals released from injured cells that initiate inflammation40. These inflammatory responses may cause cardiovascular diseases, and neurodegenerative diseases41.
Exosome treatments are gaining a lot of attention and interest in the field of aesthetic dermatology; especially with regenerative therapies being a buzzword in the field. Several manufacturers in South Korea, US and Europe have released various exosome products for use in clinics. These exosome products (or “exosome boosters” vary in their types, sources and concentrations of exosomes in the formula.
Are exosomes effective? Although exosome therapy is feted for its potential benefits in treating signs of ageing, our understanding of the science behind exosomes tremains very limited.Most of the understanding comes from pre-clinical studies; which may be limited in their application in humans. So while exosomes in dermatology sounds exciting, more studies will be required to better understand the safety issues and limitations of exosomes. Exosomes can be derived from human and animal sources; so the risk of disease transmission and initiating inflammation are theoretical risks that need to be mitigated.
Currently in Singapore and worldwide, there is no approved indication in dermatology or aesthetics for exosome therapy or skincare. This means that exosome treatments in Singapore are considered off-label. The term “off-label use” means that a drug is used for a medical condition or age group that it is not approved to treat, or administered in a different route or is not specified in the approved label. The prescription of off-label therapies like exosomes should be based on the doctor’s discretion and an informed decision made between a patient and doctor with an understanding of issues such as effectiveness, quality of scientific evidence, safety and side effects. It will take more years of research and studies on exosomes to gather data and evidence for approval by health authorities. For now, although exosome treatments in clinics, spa and skincare are growing, know that more understanding is needed and the decision to proceed should be discussed in detail with your doctor. Stay tuned for part 2 of my review on exosomes- including exosome skincare.
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