What about exosomes as an “off the shelf” orthobiologic therapy?
Today I received 4 email inquiries about exosomes.
How much human outcomes data there is on the efficacy of exosomes in orthopedics? …not much at all. Exosomes are produced locally in response to the specific environment…ie. if a joint is inflammed, the exosomes being produced may have an anti-inflammatory nature overall. This process is largely overseen by mesenchymal stem cells in the local environment. Having “off the shelf exosomes” is problematic because I have no idea about the local environment that the lab MSCs were in…maybe the exosomes in the bottle are not appropriate for the clinical situation….exosomes for tendinopathy may be very different for exosomes for knee arthritis. Exosomes for disk disease might be different from exosomes for achilles tendinopathy.
There is no clinical data showing additional benefit over just PRP or bone marrow derived stem cells..so now I have two reasons NOT to jump on the exosome bandwagon yet.
A third reason is that at $900+ dollars for a vial it is extremely expensive.
So right now, In my opinion I need a MSC that responds to the local environment and produces the relevant exosomes organically…while others prove up that the off the shelf exosome product.