What is exosome?
Exosomes are tiny, membrane-bound vesicles/globules (30-165 nanometers in size) that are released/sent from a cell and have potential roles in regulating the hair growth cycle and play an important role in intercellular communication. Exosomes are extracellular structures that can also be seen in urine, blood, saliva and cerebrospinal fluid. First discovered 30 years ago, exosomes were initially evaluated as extracellular waste materials, but later it was discovered that they play an important role in intercellular communication through molecular transfer and can transmit the biological properties of the cells they are released into to other neighboring cells. Exosomes carry DNA particles, micro RNA, mRNA, cytokines, lipids and proteins in a fat vesicle.
What is exosome therapy?
It is a new form of regenerative therapy; it facilitates processes such as tissue repair, inflammation regulation and skin renewal. It has been shown that intercellular interactions and some cell-stimulating signaling pathways can be activated with exosomes: Exosomes can stimulate the activation and proliferation of hair follicle stem cells, which can initiate the anagen (growth) phase of the hair cycle. Therefore, exosomes can be injected into the scalp to reduce hair loss and strengthen hair roots. It is ideal for efficiently delivering targeted treatments, promoting skin renewal, increasing elasticity and providing anti-aging effects.
What are the systemic activities and functions of exosomes?
Exosomes have regenerative, anti-inflammatory and angiogenic (triggering vascular formation) properties. Exosome therapy can be used to heal scar tissues by renewing the cells to which it is injected. It is used in skin pigment disorders and melasma treatments with melanocyte regulation; skin rejuvenation/anti-aging applications.
Exosomes trigger many functions such as differentiation, proliferation, mobility and formation of vascular structures in the cells they reach. Therefore, antiaging offers great promise in dermatological applications.
Exosomes have biological functions as they provide intercellular communication; therapeutic/healing effects as they can be used in the treatment of tissue damage; pharmacological activities as they have the potential to carry new drug molecules and can be used in the diagnosis of diseases as a biomarker.
Many functions of exosomes have been described:
- Intercellular signaling and communication,
- Tissue regeneration
- Immune system regulation and anti-inflammatory effect,
- Providing cellular homeostasis,
- Transport of genetic material,
- Wound healing due to mRNA coding and protein production; scar tissue improvement,
- Regenerative medicine applications,
- Diagnostic use in diseases,
- Genetic programming,
- Drug and gene transport. (Even new generation vaccines can be made using exosomes).
- Exosomes are particularly effective in cosmetic applications due to their ability to penetrate deep into the skin.
What are the sources of exosomes?
Exosomes can be obtained from baby cord connective tissue cells, placenta, fat-derived stem cell cultures, skin fibroblast cells, platelet cells (coagulation cells that we also use in PRP production), bone marrow stem cells and keratinocyte cells. After these different types of cells are multiplied in culture media, the exosomes released into the medium are collected and centrifuged at very high speeds and billions of them can be used for cosmetic purposes.
What are the non-human sources of exosomes?
Apart from human cells, exosomes can be obtained from plant origin (fruit, pollen, seed), animal origin (mollusks, ticks, milk, eggs, honey, amphibian species, silkworms and animal poisons) and microbial origin (parasites, bacteria and fungi).
What is Exosome Therapy for Hair?
Exosome therapy for hair is a new non-surgical treatment.
Studies to date have shown that exosomes help prevent hair loss by renewing hair follicles and regrowing hair. However, this treatment has not yet been standardized, but it is one of the most promising hair treatments. For example, exosomes derived from dermal papilla cells have been shown to trigger the Wnt/β-catenin pathway in the outer root sheath cells of the hair shaft, leading to a telogen-anagen transition in hair follicles in mice. In other words, exosomes have been shown to trigger the growth phase in hair follicles, thickening and vitalizing hair follicles.
How Does Exosome Therapy Work?
Exosomes help renew dormant or dysfunctional hair follicles. Exosomes activate stem cells by enabling signal exchange between cells of hair bulb and the scalp. Exosomes promote hair regrowth by releasing growth factors, cytokines, and other molecules that help rejuvenate hair follicles. In a clinical study, when exosomes purified from sebaceous stem cells were applied topically using a microneedle roller (dermaroller), significant improvements were observed in hair density (146.6 hairs/cm2 vs. 121.7 hairs/cm2) and hair thickness (61.4 μm vs. 52.6 μm).
Can Exosomes Help Treat Alopecia?
Yes, especially in autoimmune alopecia, exosomes seem to work with those diseases. In some primary cicatricial alopecias such as lichen planoplaris, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, pseudopelade, chronic cutaneous lupus erythematosus, follicular decalvans, tufted folliculitis, dissecting cellulitis, keloidal folliculitis, the body’s immune system attacks the hair follicles for an unknown reason to destroy them, resulting in permanent hair loss.
Some studies claim that exosomes may have anti-inflammatory effects. Therefore, it can be said that exosomes may be quite useful in the treatment of autoimmune cicatricial alopecias that cause hair loss. However, it is still being tested and exosome therapy has not yet been accepted as a standard treatment method for primary cicatricial alopecia.
Will exosomes regrow hair?
One day, when exosome therapy is fully standardized and in a sense perfected, it may actually be useful in reviving and renewing the miniaturized hair follicles that we call dead but are sleeping in the miniaturised form. It may be possible to rejuvenate the aging scalp and aging hair follicles with exosome therapy.
Is Exosome Therapy Safe?
Yes, it is quite safe and there are no serious side effects reported yet with exosome therapy. Exosome applications are considered safe in the hands of an experienced doctor.
A scientific study evaluated the safety of subcutaneous (under the skin) exosome injections in a case series of 31 androgenetic alopecia (genetic hair loss) patients. Exosome injections were applied to the scalp of the patients. No adverse reactions such as fever, muscle pain (myalgia), chills, fatigue or scalp infection were reported during follow-up.
In the cell culture system, it is extremely important to comply with good manufacturing practices (GMP) to minimize the risks of microbial contamination, and this increases exosome safety.
In another recent safety study, exosomes were isolated from human induced pluripotent stem cells. No evidence of hemolysis, DNA damage and cytolytic effects was observed, especially in the liver, kidneys, brain and lung; no abnormal histological findings were observed. However, more studies are needed to fully define the molecular and functional properties of exosomes obtained from different sources (plants, animals, etc. ) and to reveal their safety limits.
Is Exosome Therapy FDA Approved?
No, exosome therapy is not FDA approved. It is still a treatment under investigation and therefore has not yet been approved by the FDA. Exosomes used in human treatments in the United States are classified as a “biological product”.
How long do the effects of exosomes last?
It has not been determined exactly how long the exosomes injected into your scalp will have an effect after the therapy session. The results of their effects may be permanent or temporary. However, an idea can be obtained as a result of double-blind controlled clinical studies to be conducted with long-term and sufficient patient groups.
How Many Sessions Are Required for Exosome Treatment?
There is no standard application number and protocol determined in exosome therapies. However, 3 or 5 sessions may be required to maximize its effectiveness. The treatment plan is usually determined by the doctor according to the patient’s needs and the severity of hair loss.
How Long Does Exosome Therapy Last?
Each session can last approximately 10-15 minutes. It can usually be done several times with an interval of 2 or 4 weeks.
Does Exosome Therapy Hurt?
No, exosome hair therapy is not a painful procedure, but as in mesotherapy, patients may feel a slight needle pain similar to pulling hair on their scalp during the injection. Patients with a low pain threshold and those who are very painful may be given local anesthetics before the procedure for a painless application.
How Much Does Exosome Therapy Cost?
Exosome hair therapy costs range from $1,000 to $3,000. These prices can vary depending on the number of sessions the patient needs and where you have the treatment done.
Exosome hair restoration treatment is quite new and therefore the price range is quite wide. The price depends mostly on the location of the clinic, whether the person performing the procedure is a doctor or not, and also on the number of requests.
Do Insurance Companies Cover Exosome Therapy Cost?
No, insurance companies do not cover exosome therapy.
What are the Pros and Cons of Exosome Therapy?
Pros of Exosome Therapy:
- It has an anti-inflammatory effect and helps reduce inflammation.
- It can be used in the treatment of scars and pigmentation by helping tissue regeneration.
- There is no recovery time, pain, etc. after the application.
Cons of Exosome Therapy:
- It is an expensive application.
- The treatment accuracy has not been fully established, it is still an experimental treatment method.
- Multiple sessions may be required.
- If GMP (Good Manufacturing Practices) conditions are not followed, there may be a risk of contamination and infection during production. If good production conditions are not provided, they can spread diseases, trigger the formation of cancer cells and help cancer spread. They also have the chance to disrupt the immune system.
- There is currently no FDA approval.
Who Are Good Candidates for Exosome Hair Therapy?
Patients with alopecia areata, an autoimmune disease that causes hair loss, may benefit from exosome therapy. Because exosomes have activities that reduce inflammation, regulate the immune response and support hair regrowth.
Exosome injections can be used in androgenetic alopecia, seasonal and stress-related hair loss called telogen effluvium, in people whose hair thinning of hair has started at a young age. Exosome injections can also be used to increase success after hair transplantation.
How to Prepare for Exosome Therapy?
There is no special preparation for exosome therapy for hair loss. It is beneficial for the scalp to be clean before the procedure and injections of product.
Of course, if you are taking certain blood-thinning medications such as anticoagulants, you may need to inform your doctor and stop anticoagulant therapy for a while, as it may cause a little bleeding during your exosome treatment.
Can I use minoxidil and finasteride at the same time with exosome treatment?
You can continue using finasteride or minoxidil before or after your exosome sessions. Including exosomes in such dual combination hair treatments may further improve clinical outcomes. In a mouse model study, topical 5% minoxidil applied daily showed synergistic effects with adipose tissue-derived stem cell exosomes. In another study, 11 genetic hair loss patients who received autologous adipose tissue-derived stem cell exosome treatment combined with PRP showed better hair loss reversal compared to patients treated with PRP alone.
PRP or Exosome?
The alpha granules and growth factors found in PRP may complement the effects of exosome treatment in preventing hair loss; that is, exosome and PRP treatments can be combined. PRP therapy may be more effective in joint, tendon or ligament injuries, hair loss and skin rejuvenation treatments.
Exosome therapy may be a more suitable treatment option for chronic injuries, hyperpigmentation, autoimmune hair loss or tissue regeneration.
However, the effectiveness of exosome treatments in supporting laser, finasteride or minoxidil treatments is not fully known.
