In this video, we are going to talk about osteoarthritis and a potentially exciting recent development in the treatment of osteoarthritis – exosomes. We are going to talk about what exosomes are, where they come from, how they might work in osteoarthritis, and how effective they appear to be in early studies. Plus, we are going to go over a few exciting new health studies.

Please understand, in this video, I am not giving you medical advice. This is meant for general information and educational purposes only.

What is osteoarthritis?

Before we can talk about platelet-rich plasma and what PRP could do for you and your arthritic hip or knee, we have to discuss what osteoarthritis is.

The majority of doctors and orthopedic surgeons believe osteoarthritis is a wear-and-tear process occurring after a major injury, like a torn ACL, or over a long period of time in someone who places heavy demands on their knees or hips, like runners or people who do manual labor jobs. That wear-and-tear process takes a toll on the articular cartilage in the hip or knee, as well as the bone under it. The analogy doctors use so often is tread on a tire. The tread is the articular cartilage lining on the ends of the bones. When that articular cartilage – the tire tread – gets thinner and thinner, or even has spots where there is exposed bone, the thinking goes that you have to replace it with metal and plastic.

Osteoarthritis is a disease, a low grade, chronic inflammatory state throughout your body. When you suffer an injury, your body makes and releases proteins called cytokines that go to the site of injury. Those cytokines can be either pro-inflammatory or anti-inflammatory cells. Pro-inflammatory cytokines – the damaging ones – include interleukin-1β, tumor necrosis factor-α, interleukin-6. When there is an abundance of pro-inflammatory cytokines, they cause tissue damage in whatever part of the body that is, like the knee or hip.

If you’re out of balance, in a chronic inflammatory state – poor diet, chronic stress, disease processes that affect your immune system – you develop a situation where those pro-inflammatory cytokines recruit degradative enzymes, like metallomatrix protease, or MMP. MMP degrades articular cartilage, creating debris of damaged cells and protein, stimulating an immune response to fight it, leading to more pro-inflammatory cytokines and more degradative enzymes, and now you’re in an ongoing cycle of joint destruction.

Stem cells for osteoarthritis

Mesenchymal stem cells have been used in recent years for osteoarthritis. The theory behind them involves their potential to differentiate into different types of cells, especially bone and cartilage. And while the research is still early, most studies show improvement in inflammation and pain in osteoarthritis, but rarely do studies show the development of new cartilage and bone like it was before the degeneration developed.

Now stem cells might have a role in slowing down the pro-inflammatory process we talked about earlier. Stem cells might downregulate inflammatory signals in osteoarthritic cartilage and trigger the repair of cartilage through various growth factors.

Numerous factors have been cited as potential problems with using stem cells to heal cartilage and protect an arthritic joint, though. Creating an environment in the joint for stem cells to survive has been a challenge. Also, there is some concern that stem cells from older or unhealthy donors will lead to less cell proliferation and overall less effectiveness remains.

Exosomes, or extracellular vesicles, for osteoarthritis
Exosomes extracellular vesicles vaccine coronavirus covid 19 exocytosis molecular structure protein phospholipid transport immune 3D Illustration rendering

What are exosomes?

Exosomes are extracellular vesicles secreted by various cells and mediate intercellular communication via their contents, including lipids, nucleic acids, and proteins. Research has shown that exosomes carry proteins, lipids, and nucleic acids, including mRNA, microRNA, and long non-coding RNA, which play important roles in intercellular communications and cellular immune response.

How exosomes work

Recent studies have shown that mesenchymal stem cells-derived exosomes regulate cell migration, proliferation, differentiation, and extracellular matrix synthesis. They contribute to the repair and regeneration of cartilage by regulating immune reactivity, diminishing apoptosis, and increasing proliferation. They initiate the proliferation and migration of chondrocytes, or the cartilage precursor cells.

A recent study looking at the use of exosomes for osteoarthritis in rats showed that exosomes alleviate cartilage damage. They reduce osteophyte formation, or the development of the bone spurs we often see in arthritis. They inhibit the pro-inflammatory M1 macrophage production and promote the anti-inflammatory M2 macrophage generation. Exosomes decreased the levels of  the pro-inflammatory cytokines, IL-1β, IL-6, and TNF-α, and increased the levels of the anti-inflammatory cytokine, IL-10.

Another rat study showed similar results, namely that exosomes can effectively promote cartilage repair and extracellular matrix synthesis. Clinically, they decreased knee pain in the arthritic rats.

Doctor injecting exosomes into the knee of a patient with arthritis
Stem Cell Injection into Knee

Exosomes from embryonic mesenchymal stem cells

Getting exosomes from embryonic mesenchymal stem cells is thought to represent a potential advancement for cartilage regeneration and  treatment of osteoarthritis. In one study, researchers injected exosomes from human embryonic stem cells into joints with osteoarthritis. They observed that the damage to cartilage and subchondral bone was largely reversed at 6 weeks and almost completely restored at 12 weeks. They concluded that embryonic mesenchymal stem cells exosomes could be a cell-free alternative for cartilage repair and joint-related disease.

The current trend involves the use of exosomes derived from amniotic fluid stem cells. In one recent study looking at their use, the researchers found that amniotic fluid stem cell exosomes enhanced pain tolerance and induced an almost complete restoration of hyaline cartilage with normal cartilage surface regularity.

In another recent study, researchers showed that exosomes from umbilical stem cells stimulated chondrocyte proliferation and migration, increased synthesis of the extracellular matrix, and inhibited chondrocyte cell death. They concluded exosomes from umbilical stem cells could significantly promote the repair of cartilage defects when injected into osteoarthritic joints of humans.

FDA approval and exosomes

Like I have said in other recent videos I’ve done on other modern medicine treatments, like peptides, exosomes are not currently approved by the FDA for use in osteoarthritis. And understand that I am not giving you medical advice. This is meant for general information and educational purposes only.

Injection of exosomes for knee arthritis
Stem Cell Injection into the Right Knee

Conclusion about exosomes for hip or knee arthritis

What can we conclude from this discussion and review of current research? Exosomes appear to carry out many different functions in organisms that include repair of tissue injuries, regulation of immune response, and stopping inflammation.

And again, the research that’s out there is very early. But exosomes from stem cells can protect the arthritic joint from damage by promoting cartilage repair, inhibiting inflammation of the joint lining, and mediating subchondral bone remodeling.

If you have osteoarthritis in your hip or knee and want to avoid or delay a joint replacement, you could talk to your doctor about injecting exosomes and whether that might be an option for you.

Links to studies in the comments

If you would like to read the studies I mentioned in the video, here are links to them:

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I’m Dr. David Geier. Thank you for watching, and I look forward to helping you feel and perform Better Than Ever.