Q&A: Mesenchymal Stem Cells and Exosomes

Q: What are mesenchymal stem cells (MSCs)?

A: Adult (non-embryonic) stem cells were originally called “mesenchymal stem cells” or “MSCs.” It was originally (1980s), and until recently, believed that mesenchymal stem cells would “differentiate,” or turn into other kinds of cells. It is now readily accepted that MSCs do not differentiate, or turn into other cells.

In fact, as recent as 2016, the “Father of the MSCs,” Dr. Arnold Caplan,  has begun calling these special cells “Medicinal Signaling Cells.”  These cells are actually “nursing” cells that have the ability to nurse and/or replace dying cells, as well as regenerate damaged tissue. 

These special cells seek out areas of injury, disease, and destruction. Once there, they are capable of regenerating healthy cells and accelerating the natural healing process. 

There are increasing amounts of evidence that supports the use of cell therapies to treat autoimmune diseases, restore joint function, and many other potential uses. 

RHM uses treatments that include Adult MSCs rather than embryonic stem cells and induced pluripotent stem cells (iPS) for scientific, financial, and moral reasons. 

Both embryonic and induced pluripotent stem cells have been known to form tumors. There is currently no known occurrence of MSCs, or MSC-derived therapies, forming tumors.

RHM Physicians may, at times, use MSC-derived Exosomes for many of our regenerative treatments and therapies

Q: What are exosomes?

A: Exosomes are membrane-enclosed nanovesicles that are facilitators of cell-to-cell communication. They facilitate the exchange of biological information between different cell types. They travel to the target area, which are then taken up by the target’s cells to facilitate healing.

Exosomes are 30 nanometer to 100 nanometer lipid vesicles that are secreted by MSCs and are present in many (if not all) other fluids in the body, including blood and urine. Exosomes used for regenerative therapy are typically derived from perinatal, or after-birth materials that for millennia humans have “thrown away”: primarily, umbilical cords, umbilical cord blood, amniotic fluid, and placentas.

Q: Why exosomes rather than MSCs?

A: It’s not necessarily “Exosomes rather than MSCs.” In the treatment of some diseases, it will likely be Exosomes and MSC.

Exosomes possess a strong regenerative potential and can normalize various pathological and inflammatory processes in chronic issues. 

Um, in English, please?

As you have likely discussed with your RHM physician, inflammation is one of the biggest obstacles to achieving optimal health, or at least a better quality of life.  The small amount of data that is available in this emerging field shows us that, at this point in time, exosomes are a great starting point when initiating a regenerative therapy regimen or plan. For some, exosomes will be enough. For some, it is possible that they will need both exosomes and cells. 

Another reason why RHM begins regenerative therapies with Exosomes is simply that Exosomes, in the current market, are less expensive than cells.

Q: What are the conditions that can benefit from an exosome treatment?

A: Beneficial uses of exosomes can include, but are not limited to:

• Chronic inflammatory and autoimmune diseases 

• Chronic fatigue syndrome 

• Neurodegenerative diseases including Parkinson disease, multiple sclerosis, stroke, chronic demyelinating inflammatory neuropathies, etc (exosomes penetrate through the blood brain barrier) 

• Arthritis 

• Acute and chronic tendinitis and tendinosis 

• Muscle fatigue and muscle weakness 

• Coronary artery disease and congestive heart failure 

• Chronic hepatitis and other liver diseases 

• Chronic kidney diseases

Q: What is the source of the exosomes? 

A: Exosomes used in an RHM office are obtained from “perinatal” tissue. Perinatal tissue includes human placental cells, umbilical cord cells, and amniotic fluid. Prior to use in treatments and therapies, the donated tissues are extensively tested for a number of viruses. All Exosomes are produced in a FDA registered tissue facility that follows cGMP production procedures and holds both ISO 9001 and ISO 13485 quality control certification. The production of exosomes is regulated as a 351 tissue product by the Food and Drug Administration.

Q: How are exosomes administered?

A: For systemic illnesses (one that affects organs, tissues, or the whole body), exosomes are administered intravenously.

As a part of joint regenerative therapy, exosomes are administered via intraarticular injections (that is, injected with a needle directly into a joint).

For some therapies, exosomes are administered intranasally (into the nose).

In some cases, exosomes are administered intrathecally (injected into the spinal canal).

Q: How soon after administration of exosomes can a person expect to see the benefits?

A: Every individual is different, but two key determinants for success are the severity of your condition and your body’s response to exosome therapy. Typically, early benefits of therapy are observed in 6-8 weeks. However, it is not uncommon, to not see the full benefits until after 9 to 12 months. It is possible that some patients will experience the effects of exosome therapy within a couple of weeks.

Q: What can I expect after the procedure? Are there any side effects?

A: Exosome transplantation is typically done on an outpatient basis; most patients should expect to walk out of the office without any major pain or problems. Generally speaking, aside from the initial pain at the point of injection from the needle, the patient should not experience any discomfort. Less than 10% of (mostly intrathecal) patients have developed a minor fever, headache, nausea, or vomiting. However, these side effects have not lasted more than three days and usually resolve within 24 hours. No long term negative side effects have been reported.

Q: When can I resume physcial activity?

A: For the procedure to have the best chance of lasting benefit, RHM strongly recommends: 

• Refraining from anti-inflammatory medication, such as Tylenol, Advil, Aleve, or their generic versions 

• Resting for the first 24–48 hours, but do not lie sedentary 

If procedure is joint related: 

• Cardio is allowed after 3–4 days 

• After two weeks, weight lifting and running are permitted

Q: Are exosomes safer than stem cells?

A: It is possible that “stem cells” can proliferate, or increase rapidly in numbers, and establish in the recipient’s body possessing a certain risk of undesirable complications. While there is currently no known occurrences of Adult MSCs forming tumors, exosomes do not proliferate but rather transfer valuable biological signals to the recipient’s tissues and facilitate the normalization of various pathological processes. Therefore, it is very important to make sure that your physicians understands and is aware of your full health history.

Q: How do exosomes benefit the inflammatory processes?

A: Exosomes induce (bring about or give rise to) high levels of anti-inflammatory cytokines (any of a number of substances, such as interferon, interleukin, and growth factors, which are secreted by other cells of the immune system and have an effect on other cells), in contrast to decreased levels of pro-inflammatory molecules. In addition, they can also inhibit abnormal macrophage activation. The macrophage is a large white blood cell that is an integral part of our immune system. Its job is to locate microscopic foreign bodies and ‘eat’ them. However, disproportional macrophage activation can induce undesirable inflammatory processes. In other words, one of the many benefits of exosomes is that they help manage the body’s immune system.

Q: How does exosome therapy benefit patients with chronic infections and autoimmune diseases?

A: Chronic infections have a lot in common with autoimmune diseases, including dysregulated immune response incapable of protecting our body from intruders (bacteria, viruses, molds, etc.) while attacking its own tissues and organs thus causing significant structural damage. One of the key mechanisms controlling the direction of immune responses is a balance between specific immune cells involved in protection vs autoimmune responses (the Th17/Treg ratio). This ratio is significantly abnormal in patients with both chronic infections and autoimmune diseases. Exosomes can normalize this ratio and bring the deviant immune response back to normal.

Q: How can exosomes benefit musculoskeletal disorders?

A: Experimental data show that exosomes stimulate bone growth and skeletal muscle regeneration by directing the body’s own stem cells specifically into muscle and bone precursors (cells that have lost their stem cell properties)? 

Q: How can exosomes benefit neurodegenerative diseases?

A: Exosomes are able to penetrate the blood-brain barrier and stimulate neuronal differentiation, neuronal growth, and suppress inflammatory processes within the brain tissue.