What are Exosomes? How Do they Work?

by Chris Centeno, MD /

You may have recently seen physicians advertising exosome therapy. Or if you’re a doctor, you may have been hit up by a sales rep claiming to sell exosomes. What the heck are exosomes? Are they better than stem cells? How do they work? Let’s delve into this topic this morning

What Are Exosomes?

Cells communicate with each other using cytokines. These are proteins that are excreted by one cell and tell another cell what to do. This is one of the ways stem cells work, by orchestrating a repair response through other cells, like a conductor making sure all of the instruments produce beautiful music instead of noise.

Exosomes are little packets of stuff that bud off the outer wall of the cell. They contain everything from proteins to RNA. However, the really cool thing they can carry is mRNA.

What Is mRNA?

mRNA makes proteins. Think of it as the instruction set for certain proteins and the factory that makes them. These proteins can include everything from building blocks to chemical signals.

Cell Culture and Exosomes

When stem cells are being cultured or growing, you find exosomes in the growth media. Harvesting these and injecting them into patients has been proposed as treatment as they can contain both cytokines and mRNA capable of stimulating repair. However, there’s a bit more complexity to this story.

Exosomes Are Like Missiles

An exosome is like a missile fired by a stem cell toward a target cell. It has a payload, which is either a protein that can tell a cell what to do or mRNA, which can force the other cell to make proteins that the stem cell needs.

Dumb Missiles vs. Smart Bombs

The fantastic thing about stem cells is that they detect their environment and then act accordingly. Repairing tissue is a complex dance of cells receiving the right chemical stimulus at exactly the right time. The exosomes collected from the media of stem cells in culture are those that are needed to grow cells in culture. Basically, the signals or cross talk between cells. Given that stem cell culture is not a repair environment, the payloads of these exosomes have little to do with the repair of a complex injury. Hence, these exosomes are like missiles with the wrong, or at least not an optimal, payload. They are “dumb missiles” if collected and used as a therapy.

When stem cells are in their own environment and detect tissue that needs repair, they release exosomes that are loaded with payloads for the proteins and mRNA involved in tissue repair. They also shoot these “smart bombs” at the specific cells in the local area that are involved in the construction job and release exosomes with different payloads at different times. All of these signals are what the local environment needs to help repair the damage.

The Regulatory Issues with Exosomes

Right now, culturing stem cells in the U.S. is not permitted. Since the most common way to obtain exosomes is culturing stem cells, exosomes obtained this way are an unapproved drug product. In addition, if a company tries to isolate exosomes from something like amniotic fluid and makes claims that these can repair tissue, this is also an unapproved drug.

The upshot? Exosomes are pretty cool, but using them as therapy isn’t quite yet fully baked. Why? This is because this is a “dumb” therapy. Meaning that the nice thing about stem cells is that they’re smart and detect what’s needed to repair tissue. Hence, stem cells use exosomes like missiles, firing them at the local cells at the exact right time and in the right sequence. Knowing which payloads to load on those missiles, when, and why is something that a stem cell knows how to do and we don’t yet fully understand.

Category: Latest News

Leave a Reply

Your email address will not be published. Required fields are marked *

3 thoughts on “What are Exosomes? How Do they Work?

  1. diane conkright

    Hello Dr Centeno, I am reading all of your Regenexx blogs…thank you. Your comment a few blogs back about bovine excrement in scientific drag still has me grinning.
    However, I am a bit confused by the 4th sentence in the first paragraph of today’s blog under “Dumb Missiles vs Smart Bombs”. Is auto-correct messing with your verbage?

    (Your team has been so helpful: from the folks in Hood River, to the staff and Dr Williams in Broomfield and the staff in the Caymans. I am hoping to be scheduled with your Dr Pitts soon) Most excellent customer service.

    1. Chris Centeno Post author

      Diane, thanks for the comments. Not sure what you mean on the verbiage?

  2. Marie-Anne Lutchmaya

    Hello Chris,

    I will have same day stem cell injections to help me with my knee, hip and lower spine issues in late August 2018. This will be done at the Regenexx clinic here in Brussels.
    I have already met Dr. Janussens and Marija,his lovely assistant. They are very reassuring and try to answer all my queries as fully as possible.
    Do you ever visit the Brussels clinic? If so, do let me know the dates on which you’d be in Brussels, as I’d very much like to say hello to you.

    Marie-Anne

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
View Profile

Get Blog Updates by Email

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
Select Your Problem Area
Shoulder

Shoulder

Many Shoulder and Rotator Cuff injuries are good candidates for regenerative treatments. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist.

  • Rotator Cuff Tears and Tendinitis
  • Shoulder Instability
  • SLAP Tear / Labral Tears
  • Shoulder Arthritis
  • Other Degenerative Conditions & Overuse Injuries
Learn More
Cervical Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Knee

Knees

Knees are the target of many common sports injuries. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. They can even be used to reduce pain and delay knee replacement for more severe arthritis.

  • Knee Meniscus Tears
  • Knee ACL Tears
  • Knee Instability
  • Knee Osteoarthritis
  • Other Knee Ligaments / Tendons & Overuse Injuries
  • And more
Learn More
Lower Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Hand & Wrist

Hand & Wrist

Hand and wrist injuries and arthritis, carpal tunnel syndrome, and conditions relating to overuse of the thumb, are good candidates for regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Hand and Wrist Arthritis
  • Carpal Tunnel Syndrome
  • Trigger Finger
  • Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb)
  • Other conditions that cause pain
Learn More
Elbow

Elbow

Most injuries of the elbow’s tendons and ligaments, as well as arthritis, can be treated non-surgically with regenerative procedures.

  • Golfer’s elbow & Tennis elbow
  • Arthritis
  • Ulnar collateral ligament wear (common in baseball pitchers)
  • And more
Learn More
Hip

Hip

Hip injuries and degenerative conditions become more common with age. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures.

  • Labral Tear
  • Hip Arthritis
  • Hip Bursitis
  • Hip Sprain, Tendonitis or Inflammation
  • Hip Instability
Learn More
Foot & Ankle

Foot & Ankle

Foot and ankle injuries are common in athletes. These injuries can often benefit from non-surgical regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Ankle Arthritis
  • Plantar fasciitis
  • Ligament sprains or tears
  • Other conditions that cause pain
Learn More

Is Regenexx Right For You?

Request a free Regenexx Info Packet

REGENEXX WEBINARS

Learn about the #1 Stem Cell & Platelet Procedures for treating arthritis, common joint injuries & spine pain.

Join a Webinar

RECEIVE BLOG ARTICLES BY EMAIL

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Subscribe to the Blog

FOLLOW US

Copyright © Regenexx 2019. All rights reserved. | Privacy Policy

*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.

Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.