Examining enigmatic exosomes

What was once thought to be platelet debris or dust could be the future of cosmeceuticals. Exosomes exist as part of normal physiological activity. They are extracellular vesicles that range in size from approximately 40 to 160 nanometers. In humans, they can be found in blood, urine, umbilical cords, and bone marrow, and externally, they can be sourced from plant derivatives. These natural carriers that cells produce are responsible for delivering proteins, lipids, metabolites, DNA, and RNA.

So, why is it that they’ve only been a buzzword in medicine for the last several decades?

Glynis Ablon, MD, FAAD“In my mind, people are skeptical,” said Glynis Ablon, MD, FAAD, founder of Ablon Skin Institute and Research Center in Manhattan Beach, California, and associate clinical professor at UCLA. “There are lots of questions and lots of unknowns that have yet to be studied and answered when it comes to using exosomes in therapeutic applications.”

The fuss

Dr. Ablon understands reticence to see the potential for exosomes — it is primarily the face and skin that dermatologists are treating, after all. But to gain broader knowledge and trust, said Dr. Ablon, dermatologists need to invest in more clinical data and studies to evaluate, elucidate, and endorse the novel regimen and everything it includes.

“It is critical to conduct clinical trials to determine efficacy and dosing; you need to know what you’re doing and how to do it,” she said. “This includes what amount to use (how many billion particles are the best), what frequency, and what is the best source to get your exosomes from. They all matter as part of the process, and it’s not a simple process.”

This information is the chicken before the egg (or the egg before the chicken, depending on which theory you believe.) Without it, there can’t be approvals by the U.S. Food and Drug Administration (FDA) and the therapy will be nearly nonexistent. “Nearly,” according to Dr. Ablon, because it is currently being used for certain conditions.

In her experience, topical exosomes have shown success in several cosmetic dermatologic settings. She said to think of the “3 R’s”: repair, regrowth, and regenerate.

What is all the fuss about?

Exosomes are applied topically post-procedure or post-treatment using microneedling or laser therapy to enhance skin absorption, Dr. Ablon said. The positive outcomes that she has observed in patients include faster wound healing, hair growth, and reduced inflammation, depending on the condition at hand. Additional results may include improved skin coloration, luminosity, texture, and quality.

Dr. Ablon has seen significant improvement in patients who have skin damage, hyperpigmentation, prominent scarring, or hair-related disorders, such as androgenic alopecia or baldness. In numerous cases, she has conducted her own side-by-side comparative trials to infer these outcomes.

Most recently, Dr. Ablon has collaborated with other researchers to evaluate regenerative medicine and exosomes, a study that was accepted for publication in Derm Reviews later this year. Her research center is also currently conducting a clinical trial for the use of exosomes to regrow hair and possibly the repigmentation of gray hair.

Onward and upward

Although data on exosomal therapy is still premature in applying for regulatory approvals, there are several other factors that have limited or challenged forward movement. The ability to procure exosomes in not prevalent — batches are large, and the cost is high. Dr. Ablon said she hopes these will abate in the future, which could help boost the number of trials within dermatology.

There is also a lack of standardized treatment protocols, leading to further suspicion among doctors. Results can also be interpreted differently or be unclear when combined with other techniques or devices.

Still, it is the possibility for exosomes to be successfully used in treatment that excites and inspires Dr. Ablon, and she is looking forward to the progress that occurs and the benefits that they could provide to patients. “For me, I am excited for other potential uses of exosomes, especially in autoimmune diseases, which could lead to use in ophthalmology and neurodegenerative medicine, to name a few,” she said. “We just need to harness the knowledge so that we can go into it with the appropriate information that will allow us to get the best and most successful results.”