If you've spent any time around regenerative medicine lately, you've heard about exosomes. They're being discussed in orthopedics, dermatology, wound healing, aesthetics and, increasingly, dentistry.
Whenever something attracts this much attention this quickly, I become interested for two reasons. I want to know what's genuinely exciting about the science, and I want to know where the science ends and the marketing begins.
Exosomes deserve both questions.
THE INTEREST ISN'T REALLY ABOUT THE EXOSOME
What makes exosomes interesting is what they may be able to communicate.
Exosomes are a type of extracellular vesicle released by cells. They can carry biological cargo—including proteins, lipids and genetic material such as messenger RNA and microRNA—from one cell to another.
Think less about replacing tissue and more about cell-to-cell signaling. Researchers are investigating whether these tiny biological messengers can influence processes involved in inflammation, angiogenesis, immune response, tissue repair and regeneration.
For implant dentistry, the obvious question follows: Could those signals eventually be used to help create a more favorable regenerative environment?
THAT'S A VERY DIFFERENT IDEA FROM STEM CELL THERAPY
One reason exosomes have attracted attention is the possibility of influencing regenerative processes without transplanting living cells themselves. Instead, researchers are studying whether some of the signaling activity associated with cells can be harnessed through the extracellular vesicles they release.
That's an intriguing concept, but an intriguing mechanism and a predictable clinical treatment are two very different things. The source of the exosomes matters, as do isolation, purification, characterization, concentration, storage and delivery.
If two products both have “exosome” written on the label, that doesn't necessarily mean they're biologically equivalent.
THIS IS WHERE DENTISTS SHOULD ASK HARD QUESTIONS
I'm not a dentist, but I've spent my career around marketing, and I know what happens when an exciting scientific term develops commercial value. The marketing can move much faster than the evidence.
So I'd want to know what you probably want to know. What has actually been demonstrated in human clinical research? What remains preclinical? Are preparations standardized? What dose is appropriate? How should they be delivered? How long do their effects last?
And perhaps most importantly, what outcomes have actually been shown rather than simply proposed?
Those questions don't make someone anti-innovation. They're how you separate an emerging clinical tool from an emerging sales pitch.
WHERE COULD PRF AND EXOSOMES INTERSECT?
This is where the subject connects naturally with the PRF discussion from my previous article.
PRF provides an autologous fibrin matrix containing platelets, leukocytes and signaling molecules. Exosomes introduce another potential layer of biological communication, and researchers are investigating how extracellular vesicles might eventually be combined with regenerative scaffolds and existing approaches such as PRF.
That doesn't mean the combination is ready to become routine clinical care. It means there's enough interesting biology here to justify serious investigation.
And I'd much rather hear that investigation from someone doing the research than from someone trying to sell me the excitement.
PROMISING ISN'T THE SAME AS PROVEN
That's really the theme running through everything I've learned while putting this series together. New isn't automatically better, biological plausibility isn't the same as clinical proof, and no technology eliminates the complexity of the individual patient.
Dr. Richard “Rick” Miron is going to dig into exosomes, PRF and the evolving science of regenerative dentistry at Biology in Dentistry, the free live virtual Dental Summit I'm hosting on Thursday, October 29. He'll examine what exosomes are, how they're characterized, their potential applications and what the research may mean for regenerative dentistry.
If you place implants or perform regenerative procedures, I think this is a subject worth understanding before the marketing gets any louder.
To your unstoppable success,
President
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