Dr. Al Danenberg ● Nutritional Periodontist
October 15, 2019
Exosomes are one of the exciting areas of healing research in the medical world. Exosomes are not new. They are extracellular vesicles, which were first described 30 years ago. The interest in exosomes today is that they are released from cells into the extracellular environment, and they can affect other cells in various ways.
Benefits of Exosomes
Exosomes possess three unique qualities. First, they provide a means of communication between cells as well as a means of transmission of biological molecules to cells. Second, exosomes assist in the spread of proteins, lipids, and genetic material. And third, they may be a perfect vehicle for administering drugs in a more biological way to individual cells.
Exosomes may promote significant positive effects on tissue damage. They can enhance tissue regeneration and repair through reducing inflammatory responses, promoting proliferation, inhibiting apoptosis, and facilitating angiogenesis.
But it needs to be emphasized that exosomes could produce disease based on the donor. They may act as vehicles to spread disease-producing proteins to various cells in the body. For example, neurodegenerative-associated peptides could be transmitted by contaminated vesicles that could result in diseases like Alzheimer’s, Parkinson’s, and ALS.(,,)
Source of Exosomes()
Exosomes are an important ingredient of Mesenchymal Stem Cells (MSCs). MSCs can be easily obtained from a variety of tissue organs such as bone marrow, adipose tissue, and umbilical cord.() Compared with other MSCs, human umbilical cord mesenchymal stem cells may be the best choice because of low cost, minimal invasiveness, convenient isolation, large cell content, and low effect on the immune system.()
Application in Dentistry
Exosomes have been shown to be beneficial in the treatment of periodontal defects. In this 2019 peer-reviewed medical paper, researchers studied the healing effects of exosomes in rats.
The investigators created periodontal defects in 18 rats. Three study groups were created. One group had no medicament placed in the periodontal defect during healing. The second group only received a collagen sponge as a medicament placed into the defect. In the experimental group, an exosome-loaded collagen sponge was placed into each periodontal defect. The clinicians observed that the periodontal defects in the exosome-treated rats developed new bone and periodontal ligament (PDL) regeneration more efficiently than that of the other groups following a 4-week healing process. They also observed there was increased cellular infiltration and proliferation. The authors concluded that the exosome-enhanced regeneration occurred through a synergistic combination of enhanced cell viability, migration, proliferation, matrix synthesis and differentiation to form new bone and PDL attachment. This study demonstrated for the first time that exosomes improved periodontal regeneration. The scientists also stated that exosomes derived from Mesenchymal Stem Cell (MSC) are a viable ready-to-use and cell-free treatment for periodontal defects.
There are tissue banks which provide human umbilical cord exosomes for clinicians. These can be applied to biological transport media like collagen sponges and easily be used during regenerative surgical procedures. This is an area of increased interest. The study I cited above is the first to show the benefits of exosomes in regenerating periodontal tissues. There will be many more studies as time goes by to standardize the exact procedures in order to obtain the ideal results. I am excited about the potential of this natural human-derived product.