General Disclaimer: This blog is for informational purposes only. It is not an advertisement for exosomes. Use of exosomes has not been FDA-approved for prevention nor treatment of any disease condition. Anecdotes provided do not constitute scientific proof and all patients were treated in the context of a fully informed consent and patient-physician relationship.
A patient whom I treated sent a 3-minute video of talk show host, Joe Rogan, explaining how he feels exosomes fixed his shoulder labrum tear. The shoulder is a particularly hard-working and amazing joint and the problems can be many. Most commonly, the rotator cuff has tears, the subacromial bursa is inflamed and impinging on the rotator cuff tendons, or the glenohumeral labrum is torn.
After spending last Saturday in lectures with similar anecdotes, I began to consider my own patients’ experiences and what I’ve learned. I want to explain three things: musculoskeletal (MSK) injury is stem cell exhaustion, stem cells and their exosomes can overcome this impasse, and that the time course of repair is occurs in phases.
Last month, I attended a great seminar on ultrasound-guided joint injections taught by a brilliant clinician, Dr. Fran O’Conner. In fourteen hours, he taught us the anatomy, clinical assessment, joint injections, and ultrasound techniques for ameliorating the common MSK conditions such as osteoarthritic hips and knees, rotator cuff injuries, tennis elbow, carpal tunnel, plantar fasciitis, and patellar tendon sprains.
The common theme was that chronic tendinosis, like osteoarthritis, is not like acute injury. There is no white blood cell accumulation nor inflammation per se. I came to realize that the reason he advised caution against injecting tennis elbow, de Quervain’s tenosynovitis, and Achilles tendinopathy is that steroids can cause atrophy of those already worn out tendons. The same caution applies to injecting encapsulated joints as steroids are chondrotoxic. This means that all the potential repair that the local stem cells can muster has already been exhausted, probably from telomere erosion and senescence. See my video www.tinyurl.com/exosomes5 for an explanation of this.
Thankfully, as Joe Rogan found out, the introduction of exosomes from MSCs can catalyze a shift back to regeneration and repair. I would like to spend the rest of this blog explaining my thinking about time course of repair. To do this, I refer you to a mash up of my foot. Five weeks ago, after surfing in Kau’ai, I made the mistake of coming ashore on volcanic rocks. I lacerated my foot and stepped on a sea urchin. This left over twenty small spines all over my foot that could not be removed. I should have anesthetized my foot but instead followed the local knowledge and soaked it in vinegar.
Suffice it to say, it didn’t get rid of the spines and the foot was hard to walk on for a week but now, after five weeks, it is fine and my body absorbed them. It took time. If you look at the gashes, the dermal lacerations filled with fibrin and scarred up; eventually at 4 weeks, the scab was falling off and now at 5 weeks, it is almost back to normal.
So it dawned on me: if the highly vascular foot takes this long to reorganize, then the joints and the tendons might also need at least this long to repair. My first patient, 10 weeks ago, is Doug, and a couple of days ago he noted that his knees were better than they’ve been in years. The pilot who took two injections says he is 80% improved and able to play tennis after 7 weeks. Now it is tempting to consider that perhaps time would have healed them but the fact is that the pilot was injured for months without improvement and Doug has had worsening knees for decades; again, stem cell exhaustion means incomplete repair.
Finally, I want to hypothesize about the mechanisms of exosome action and the clinical presentations. Interestingly, some people feel immediate pain relief, unlike when platelet rich plasma is added. I believe this is from a euphoria and shift in the inflammatory/neurological pain milieu. Chronic pain, as Dr. O’Conner explained, is a CNS condition. In the first three days, I believe apoptosis is occurring with increased pain from clearance of dead cells. This is corroborated by the pilot’s noting of lymphadenopathy. Around two weeks in, new cells appear to be coming on line with the advent of odd and brief twitching of new muscle bundles. But the remodeling and regeneration by cell reproduction appears to take time as in the case of my foot and the shoulders of my pilot and Joe Rogan.
Is the effect of the exosomes lasting beyond four weeks? Yes and no.The exosomes themselves are gone or diffused away but the apoptosis, changes in inflammatory profiles, de-differentiation, new recruitment of stem cells, and remodeling are effects that persist. It is possible that to increase the local action of exosomes, a medium such as PRP (platelet rich plasma) or PRFM (activated platelets) is needed. I am leaning towards using large molecular weight hyaluronic acid for joints to serve this function. Another thing I learned from the clinicians, Dr. Spiel and Sanders, is that the amniotic fluid exosomes have a synergistic effect with the MSC-exosomes in MSK indications, possibly due to the high amount of hepatocyte growth factor (HGF) that plays a role in regeneration and would healing.
So if you are coming in for MSK treatment, I will now be able to offer you exosomes of two types, with a hyaluronic acid medium, guided by ultrasound injection. I am looking forward to patiently waiting the 8 weeks needed to have what could be life-transforming repairs beyond what the body is naturally able to accomplish in the face of exhaustion of locally-available stem cells.
Feel free to bookmark the following link to have all my exosomes videos at your fingertips!
Archived exosome blogs….Please read them all.
N.B. On 2/29/2020 I changed my philosophy about keeping these blogs private. The archives up to blog 32 were appended to blogs that had yet to be created when the earlier ones were first written.
I still have voluntary ASMR. Mom’s arthritis is greatly improved.
I explain why I believe exosomes aren’t inert. An amazing case of an overnight in heart rate variability is presented.
A case of whiplash and traumatic brain injury improved after exosome use.
After exosome injection, two runners were able to return to running after limitations from tendinosis that plagued them for months (in the case of the 60-yo man, and years (in the case of the 53-yo woman)
In this blog, I discussed how complicated clinical medicine can be. Different treatment protocols, ambiguous results ethical dilemmas and strange phenomena like acquired coffee aversion are part of what make treating with exosomes so challenging.
Using my left foot as an example, I attempt to explain that while some exosome effects are immediate, others take time. Remodeling of damaged tissues is a complicated process. My foot is still scarred and probably will be for life.
A patient after dental exosome injection becomes pain free after 4 years of suffering.
I explain why lab testing of freshly thawed exosomes is SUPPOSED to come back as normal saline.
A nine-part comprehensive explanation of exosomes.
I interviewed the principal scientists of Kimera Labs and other experienced clinicians using exosomes
66-yo Deb B went from not being able to do one squat to 100 per day after exosome injection.
80-yo Doug describes in his video how much his knees have improved since getting exosome injections. He is reaching new athletic peaks with no signs of stopping.
My 82-yo mom underwent microneedling with exosomes with fantastic results. Most impressive was the absence of “downtime” from redness or bruising.
54-yo weightlifter with chronic pain from a rotator cuff tear shows remarkable improvement in just four days! He re-injured it at the gym so had to undergo a repeat shoulder injection
48-yo woman with severe face blindness experiences some improvement after nasal injections of exosomes. Her ability to remember new faces has improved permanently
I delivered two lectures in Hawaii. The first was about exosomes generally and the second is a password-protected video about clinical applications.
Three cases of middle-aged women reporting enhanced enjoyment and renewed capacity to read after nasal exosome therapy
Two cases of improved dental health presented. We discuss the hazards of EMF and the promising future of dental regenerative therapy
We discuss the notion of energy centers known as chakras and the fact that we are electrical beings
A case of improvement in Seborrheoic Dermatitis after microneedling with MSC exosomes is presented.
I explain how poor we are at assessing change and how attribution and recall bias play important roles
In the past year, there has been a lot of shifting loyalties in the exosome space resulting in a lot of rumor, innuendo, and bad press. With various parties trying to get each other in trouble with federal regulators, it is a treacherous business to be in.
I describe a case of an 86-yo woman whose chronic leg rash disappeared after improvement in her leg circulation
I use a car wash analogy to answer the question “how long do exosomes last?” The answer is it depends on how dirty and damaged the car is, how well you clean it, and how dirty you get it after washing.
I describe four cases of improvement of osteoartritic knees from my trip to Hawaii.
I explain the three definitions of placebo and why I believe most of the effects of exosomes cannot be attributed to the so-called placebo effect.
Some remarkable “soft signs” of exosome effects include itching (new nerves), twitching (new muscles), and heaviness (a healing FORCE).
Three amigos came to see me and all enjoyed benefits. The best was the 48-yo gentleman who had a dramatic improvements to his irritable bowel syndrome, varicose veins, and appearance.
I address the common observation from patients that exosomes seem “smart” or that they know where to go. In fact, I doubt this is true and that they are no smarter than player piano scrolls are good musicians.
I gave a lecture at the University of Hawaii with about 80 attendees. Around 10 of them were actual patients. Hear in their own words how exosomes helped them.
I describe two cases of improved leg swelling and explain what causes this common condition and how exosomes may be improving it.
We present an amazing case of overnight nerve regeneration after ultrasound-targeted exosome injections.