In the fascinating realm of Aesthetic Medicine, Dr Debbie Norval introduces us to exosomes—small, powerful messengers that cells release. These tiny vesicles, laden with essential information, shuttle between cells, influencing regeneration and communication within our bodies. Dr Norval sheds light on how exosomes are revolutionising the field of aesthetics, offering promising prospects for skin rejuvenation, hair rejuvenation, wound healing, and beyond.
Exosomes are tiny vesicles (small, fluid-filled sacs) released by cells, acting like microscopic pocket rockets of information, shuttling vital messages between cells in the body. They play a vital role in cellular communication and regeneration.
Exosomes are the new kid on the block in the field of Regenerative and Aesthetic Medicine. We are familiar with other forms of regenerative medicine such as the use of biostimulators and bio-remodellers, growth factor therapy and platelet rich plasma. The use of stem cells and nanofat for skin rejuvenation is also gaining popularity.
With a focus on prevention, restoration and wellness, regenerative therapies are ushering in a new era of healthcare, and exosomes are showing huge promise in many fields of medicine.
What are exosomes?
Exosomes are small extra-cellular vesicles that are released by cells into the environment outside of the cells. These tiny pockets of information travel in the extra-cellular fluid, between cells, not within cells.
Exosomes contain proteins, lipids and nucleic acids (such as RNA) that are specific to their cell origin and deliver their cargo to both nearby and distant cells with high efficiency.
They influence the behaviour and function of other cells, playing a crucial role in immune system modulation, tissue repair, and other physiological processes.
The main functions of exosomes
In Aesthetic Medicine, exosomes are used for several purposes including skin regeneration (new collagen and elastin), immune modulation and anti-inflammatory (reduced reactions and faster healing). They enable cells to live longer and they reduce scarring. So it’s not surprising that exosomes are used for skin rejuvenation, hair regrowth, wound healing, scar treatment, fat reduction, pigmentation, vaginal rejuvenation and complication management.
Use of exosomes in medicine
Exosomes are also widely used in general medicine; there are several studies to show the effects of exosomes in neuro-degenerative diseases e.g. Motor Neurone Disease and Parkinson’s, orthopaedics, immunology, cardiovascular disease, periodontal disease, wound and scar management. Exosomes are also being explored in Oncology.
Advantages of exosomes
Exosomes can be engineered in a laboratory to target specific cells. This allows precise delivery of therapeutic agents to these cells.
The small size of exosomes enables them to penetrate tissues and cross biological barriers, including the blood-brain barrier.
Exosomes are not recognised as foreign. This removes the limitations of autologous procedures, which, like platelet rich plasma or fat grafting, allow patients to only use their own tissues. Exosomes, in contrast, can be given to anyone and not be rejected.
Exosomes also naturally suppress inflammation and promote tolerance.
Comparing exosomes to platelet rich plasma (PRP)
Both PRP and exosomes contain growth factors. However, exosomes contain a wider range of bioactive molecules than PRP, including nucleic acids, lipids, and proteins while PRP mainly contains growth factors. Exosomes are smaller than platelets and can penetrate tissues more easily. They can be freeze-dried and stored for a long time, while PRP needs to be prepared fresh for each use by a patient using their own platelets.
Exosomes in wound healing and scar management
Exosomes modulate wound healing by delivering growth factors, cytokines, and other signalling molecules to the site of injury. These stimulate the migration and proliferation of cells involved in tissue repair.
Studies show that exosomes accelerate wound closure rates and improve the quality of healed skin, with increased collagen synthesis. They enhance new blood vessel formation and reduce inflammation and scarring by inhibiting the overproduction of collagen and other extracellular matrix proteins that contribute to the formation of scar tissue.
Exosomes and hair rejuvenation
A study on exosomes derived from Human Hair Follicle Mesenchymal stem cells (hfMSCs) demonstrates that exosomes promote hair growth by activating signalling pathways involved in hair follicle development and maintenance. Exosomes also increase the production of Vascular Endothelial Growth Factor (VEGF) promoting the increase of blood vessels and oxygen to the hair follicle cells.
How are exosomes administered?
Exosomes can be administered in every way possible!
They can be given via an intravenous infusion, as an intramuscular injection, through nebulisation, or nasal and eye drops. In Aesthetic Medicine, they are administered as a serum during micro-needling or ablative skin resurfacing treatments like Fraxel® or Tixel®. They can also be administered as site-specific direct injections into problem areas or scars. Exosomes are also becoming available as topical serums or creams for home use.
Challenges with exosomes
Exosome therapy is a relatively new and emerging field and there are currently no standardized guidelines or regulatory frameworks in place for clinical use. This creates challenges for their development and commercialization.
Unfortunately, there are fly-by-night unethical companies who are producing “exosomes” and selling them at high prices to desperate and vulnerable patients hoping for a miracle cure for motor neurone disease, cancer or hair loss.
The US Food and Drug Administration (FDA) has the authority to regulate regenerative medicine products, including stem cell products and exosome products. The FDA warns that there is currently a lot of misleading information on the internet about these products, including statements about the conditions they can be used to treat.
There are currently no FDA-approved exosome products.
In spite of the potential misuse, exosomes present an exciting new form of therapy in medicine. They are biocompatible, biodegradable, with low immunogenicity, making them an attractive alternative to traditional drug delivery systems and cell-based therapies. This holds great promise for future clinical applications.
MBBCh (Rand) Dip Pall Med (cUK) M Phil Pall Med (UCT) Adv Dip Aesthetic Med (FPD)
Dr Debbie Norval graduated as a medical doctor from the University of the Witwatersrand, in 1991. Post graduate training includes a Diploma in Palliative Medicine through the University of Wales, Masters of Philosophy from the University of Cape Town, an Advanced Diploma in Aesthetic Medicine through the Foundation for Professional Development and a City and Guilds Diploma in Adult Teaching and Training.
Dr Norval is the convenor of the Johannesburg Aesthetic Doctors Journal Club and sits on the scientific committee of the Aesthetic Medicine Congress of South Africa (AMCSA). She is the Past President of the Aesthetic and Anti-Aging Medicine Society of South Africa (AAMSSA) and serves on the International Advisory Board of CMAC (Complications in Medical Aesthetics Collaborative).
“Dr Debbie Norval Aesthetics” is a busy clinical practice in Parktown North, Johannesburg.