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This is not a recent discovery. The role of exosomes as key regulators in cell-cell communication has been the subject of years of history and research, but they have recently gained popularity in the field of aesthetic medicine thanks to their regenerative power. Among other benefits, exosome treatment helps to improve the appearance of the skin, reduce blemishes, wrinkles and acne scarring, but its use is not yet protocolised. And although some specialists have experimented beyond its application as a cosmetic product – with positive results in its application in the form of mesotherapy on the face and hair – there is a lack of scientific evidence.
“Exosomes are small vesicles released by stem cells containing a wide variety of biological molecules such as lipids, proteins, RNA and enzymes. Initially they were presented as waste vesicles, a claim that was later eliminated when it was shown that they are excellent messengers between cells, as they have the capacity to transfer genetic information and proteins with the ability to modulate the functions of the receiving cells,” says Dr Alicia María Tamayo Carbón, a first and second degree specialist in Plastic Surgery and Caumatology.
Drs. Tamayo and Anaya giving a personalised course on facial lipotransfer.
As an expert in the field of innovation in regenerative medicine with stem cells derived from adipose tissue, Tamayo acknowledges that the current trend is towards regenerative therapy to practice procedures with natural products and minimally invasive technology, with an evolution towards safer and more innocuous treatments. “The main advantage over other regenerative elements is that there is no risk of their differentiation into malignant cells,” warns the surgeon.
As for their repairing power, the distinctive feature that has made them famous recently, Tamayo points out that exosomes act “on all phases of healing due to their ability to modulate inflammation, activate the migration and proliferation of various cells, including immune cells, fibroblasts and keratinocytes”. In addition, says the specialist, they induce proliferation, the expression of N-cadherin, cyclin 1, PCNA, collagen I/III and elastin, which results in a reduction in scar formation. On the other hand, continues the expert, who also works as head of the Plastic Surgery and Burns Service at the Hermanos Ameijeiras Hospital, exosomes improve neovascularisation and the survival of cutaneous collagen by reducing inflammation and apoptosis.
Research on exosomes also demonstrated their involvement in delaying cell ageing processes. “They confer anti-senescence effects through their unique content of miRNAs, lncRNAs and enzymes. By inducing proliferation and reducing senescence in cells, they have great potential to decrease senescence in tissues, which creates a pro-regenerative environment and cellular homeostasis, being an approach to induce tissue regeneration and rejuvenation. They also promote epidermal barrier repair through the production of ceramides and dihydroceramides,” says Tamayo.
Which method is indicated, is there a standardised protocol for exosome treatment, topical or microneedling? Although they are currently promoted in many centres as treatments that go beyond their cosmetic use, thus increasing their ability to penetrate beyond the dermis, there is as yet no standardised protocol. In fact, the Spanish Society of Aesthetic Medicine (SEME) recently issued a statement to clarify some doubts that have arisen from the publicity given to exosomes in the field of aesthetic medicine.
“We have observed how their use is protocolised as injectables, although the marketers themselves present them objectively and officially as cosmetics,” the text of the report points out. Therefore, in view of this discrepancy, SEME decided to consult the Spanish Agency for Medicines and Health Products (AEMPS), which provided the following response:
*Exosomes are extracellular communication vacuoles rich in proteins, lipids, messenger RNA, mitochondrial RNA, DNA and various growth factors. *The use of exosomes is very new, they are ingredients whose nature is complex and variable, they are not listed in the annexes of Regulation 1223/2009 which restrict the composition of cosmetic products, therefore, it is up to the person responsible for each product (for its manufacture) to demonstrate that its use is safe. However, it must comply with some general criteria, e.g. that no cells, tissues or products of human origin could be used.
On the other hand, SEME insists; the legal definition of cosmetic product states that it is “any substance or mixture intended to be placed in contact with the superficial parts of the human body (epidermis, hair and capillary system, nails, lips and external genital organs) or with the teeth and oral mucous membranes, with the exclusive or main purpose of cleaning, perfuming, modifying their appearance, protecting, maintaining them in good condition or correcting body odours”.
Consequently, a cosmetic product cannot be designed to be applied with a device that takes it beyond this layer of the skin, such as micropunctures, microneedling, mesotherapy, iontophoresis. “Nor are cosmetic products those that are intended to be injected, ingested or inhaled. Cosmetics can never be injectable products or act at the level of the dermis,” says SEME.
Since the functions of exosomes are closely related to the structural characteristic of the cell that gave rise to them, their function, the state of vitality and the evolutionary phase they are in, they have a number of applications,” says Tamayo. But so far, their indication in isolation is only for cosmetology. The rest is still experimental, and although very good results may have been obtained, it must be emphasised that there is a lack of scientific evidence to demonstrate both their safety and efficacy.
