As standard practices continue to evolve, diagnosing any advanced burns are now calling for new considerations for the prevention of burn-related complications. As more and more after-effects from high degree burns have left patients with lasting (and sometimes fatal) results, it may no longer be enough to drive a treatment protocol based on surface topical healing.
Second and third-degree burns may show blisters and red skin but with today’s many non-invasive subdermal technologies, you can now identify the depth of the burn and what the injury truly means under the skin. Identifying the exact DEPTH of the internal injury as well as monitoring (visually) its internal impact/effect on the body may uncover and predict other potential health issues such as:
According to Image 1A, high resolution sonogram used a standard probe for skin imaging showing the black area, which is just below the white line of the surface and the black fluid corresponds to the blister seen on the specimen of the burned area. Now below it you see the skin with the first vertical blue dotted line and it goes to the fascial plain white line, which shows swelling of the tissues. The normal skin measures 1.3 millimeters or thin as a dime and the depth of the burn itself measured is twice that, 2.6 millimeters. So we have a way of seeing the fluid. We have a way of checking the depth of the burn, which is clinically difficult because the eyes cannot see below the skin. You can see the blister is basically gone because that's the tiny black area above the tissue line- showing almost no fluid left (represented In the blackish area)
Upon review of Day 9 diagram, see "burn healing" on the left side of this diagram where it says dermis on day 9, you can see the bottom white line under the lettering dermis, which shows the bottom of the skin, which last time was 1.3 millimeters. Then to the right of that the dermis tissue is starting to have the red and blue healing blood vessels that's coming in marked by the red arrow. And then to the right of that where it says decreased vascularity, the larger blood vessels have not yet come in, but at least we know the skin has viable feeding blood flow. So it's more likely than not to heal.
INTRODUCTION
Our publication's first interaction with Dr. Jordan Plews was during HealthTech Reporter's pilot program where
Dr. Robert Bard conducted a performance test of the ELEVAI Exosomes product (Image R). Dr. Plews, CEO of Elevai collaborated with BardDiagnostics to explore quantifiable effects of the skin regenerative product, offering a new way of monitoring the progress of a topical serum. This "test drive" employed the use of hospital-grade 3D Ultrasound, showing remarkable epidermal and subdermal progress with Dr. Plews' exosomes' during a limited time period.
The exploratory relationship continued to grow as both clinical minds entertained other potential benefits of extracellular vesicles (EVs) for its directed use and beyond. The expansion of regenerative medicine brought Drs. Bard and Plews a common appreciation for each others' work in the spirit of publishing new findings for the progress of exosome science as future co-investigators. This is also evident in this latest report on "Wound Healing & Exosomes for the Skin"- where Dr. Plews brings a clear path of understanding about the regenerative potential for platelet-derived extracellular vesicles.
UNVEILING THE POWER OF CELLULAR COMMUNICATION
Written by: Jordan R. Plews, PhD
As a biochemical engineer, molecular biologist, and stem cell researcher, I'm constantly fascinated by the body's intricate communication networks. One particularly exciting area is the field of exosomes, tiny extracellular vesicles released by cells that act as messengers, carrying vital cargo to influence the behavior of recipient cells. In the realm of dermatology, exosomes hold immense potential for promoting and supporting skin health and regeneration. However, it's crucial to understand not only the source of these messengers but also the specific content they deliver for optimal results.
Exosomes: Nature's Nanoscale Communication Network
Exosomes are naturally occurring, membrane-bound nanoparticles (30-150 nm) secreted by various cell types. They carry a rich cargo of proteins, lipids, and genetic material, including messenger RNA (mRNA), microRNAs (miRNAs), and long non-coding RNAs (lncRNAs) [1]. This molecular payload allows exosomes to act as intercellular signaling units, influencing the behavior of recipient cells.
In the context of skin, exosomes play a vital role in various processes. They contribute to wound healing, tissue regeneration, immune modulation, and even pigmentation regulation [2, 3]. However, it's important to differentiate between exosomes derived from different cell sources.
Plant vs. Human Exosomes: A Tale of Two Kingdoms
The recent surge in interest in exosomes has led to the exploration of plant-derived options. While plant exosomes may possess intriguing properties, it's crucial to recognize the fundamental limitations. Human and plant cells belong to distinct biological kingdoms with vastly different cellular structures, signaling pathways, and metabolic processes [4]. Therefore, plant exosomes might not be well-suited for addressing human skin concerns. Their cargo may not effectively interact with our cellular machinery, hindering their ability to deliver the desired effects.
Platelets vs. MSCs: Unveiling the Superior Source for Skin Rejuvenation
Platelet-derived extracellular vesicles (EVs) have garnered considerable attention in aesthetics. However, as a stem cell researcher, I find them to be a limited source for comprehensive skin rejuvenation. While platelet EVs offer some beneficial growth factors, their cargo is comparatively restricted compared to exosomes derived from mesenchymal stem cells (MSCs) [5].
MSCs are multipotent adult stem cells with the remarkable potential to differentiate into various cell types. Importantly, MSCs can be isolated from numerous adult tissues, including bone marrow, adipose tissue, and even umbilical cord and placenta [6].
The Power of Younger Sources: Unveiling a Superior Exosome Profile
Interestingly, the source of MSCs significantly impacts the exosome profile. Human MSCs derived from younger sources, such as umbilical cord (hUMSCs) and placenta exhibit several advantages over those from bone marrow or adipose tissue [7, 8]. Here's why:
1. Enhanced Proliferative Capacity: Younger MSC sources possess a higher proliferation rate, leading to a greater yield of exosomes for therapeutic applications, and have been shown to improve the function of older MSCs [9].
2. Superior miRNA and Growth Factor Profile: hUMSCs secrete exosomes rich in specific miRNAs and growth factors known to promote cell proliferation, migration, and tissue regeneration [10, 11]. These factors include vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), and epidermal growth factor (EGF), all crucial players in the wound healing cascade.
3. Potent Anti-Inflammatory and Immunomodulatory Effects: Exosomes from younger MSC sources display pronounced anti-inflammatory and immunomodulatory properties [12]. This is particularly beneficial for addressing conditions like chronic wounds or acne, where inflammation plays a key role.
Harnessing the Power of Exosomes for Skin Regeneration: The 4-Phase Wound Healing Cascade
The human body possesses a remarkable ability to heal wounds through a well-defined, four-phase process:
● Hemostasis (0-1 day): This initial phase focuses on stopping bleeding through platelet aggregation and clot formation.
● Inflammation (1-3 days): The body initiates an inflammatory response to remove damaged tissue and prepare for repair.
● Proliferation (3-21 days): New blood vessels are formed, and fibroblasts migrate to the wound site to synthesize collagen, the building block of new tissue.
● Remodeling (~14 days – 2 years): The newly formed tissue matures and strengthens, eventually returning the skin to its pre-injury state [13].
Exosomes sourced from young MSCs, such as human umbilical mesenchymal stem cells (hUMSCs), hold tremendous potential to support each phase of this process. Their cargo of growth factors can accelerate the proliferation phase, while their anti-inflammatory properties can shorten the inflammatory phase. Additionally, miRNAs contained within these exosomes can regulate gene expression to promote tissue repair and regeneration [14].
Conclusion
In conclusion, exosomes represent a promising frontier in dermatology. However, it is crucial to select the right exosome source for optimal results. While plant-derived exosomes may offer some benefits, human-derived exosomes, particularly those from younger MSC sources, provide a superior profile of bioactive molecules to more effectively address a broad array of skin concerns, as many trace back to lack of completion of the canonical four phases of wound healing. By understanding the science behind exosomes and the intricacies of the wound healing cascade, we can harness their power to promote healthier, younger-looking skin.
ABOUT THE AUTHOR
Dr. Jordan R. Plews is an expert at the intersection of biochemical engineering, stem cell research, and regenerative medicine with a particular focus on the cellular and molecular mechanisms of aging and human longevity. He graduated with 1st class honors in Biochemical Engineering from the University of London and completed doctorate research in Molecular Biology and Stem Cell Research at University College London, specializing in Somatic Cell Reprogramming. After working as part of Pfizer's bioprocess development group in bioprocess design and scale up, he conducted postdoctoral research at Stanford, looking at ways to apply stem cells in inventive and practical ways to treat disease. He held key roles at med/biotech companies like Velos, Becton Dickinson, and Xytogen Biotech, where he developed innovative products for researchers, clinicians, and consumers. At Natera, he lead the launch of Signatera, a personalized genomics based cancer diagnostic. In 2020, he co-founded ELEVAI, creating advanced skincare solutions using human stem cell exosomes. His research, published in leading journals, explores the relationship between stem cells, aging, and disease to enhance and extend healthy lifespan.
References
1. Raposo, G., & Stoorvogel, W. (2013). Extracellular vesicles: exosomes, microvesicles, and friends. Journal of Cell Biology, 200(4), 373-383.
2. Qin, Xinchi, et al. "The functions and clinical application potential of exosomes derived from mesenchymal stem cells on wound repair: a review of recent research advances." Frontiers in Immunology 14 (2023): 1256687.
3. Liu, Ying, Haidong Wang, and Juan Wang. "Exosomes as a novel pathway for regulating development and diseases of the skin." Biomedical reports 8.3 (2018): 207-214.
4. Bloemendal, S., Kück, U. Cell-to-cell communication in plants, animals, and fungi: a comparative review. Naturwissenschaften 100, 3–19 (2013). https://doi.org/10.1007/s00114-012-0988-z
5. Anderson JD, Johansson HJ, Graham CS, Vesterlund M, Pham MT, Bramlett CS, Montgomery EN, Mellema MS, Bardini RL, Contreras Z, Hoon M, Bauer G, Fink KD, Fury B, Hendrix KJ, Chedin F, El-Andaloussi S, Hwang B, Mulligan MS, Lehtiö J, Nolta JA. Comprehensive Proteomic Analysis of Mesenchymal Stem Cell Exosomes Reveals Modulation of Angiogenesis via Nuclear Factor-KappaB Signaling. Stem Cells. 2016 Mar;34(3):601-13. doi: 10.1002/stem.2298. Epub 2016 Feb 19. PMID: 26782178; PMCID: PMC5785927.
6. Dominici, M., Le Blanc, K., Mueller, I., Slaper-Cortenbach, I., Marini, F., Krause, D. E., ... & Horwitz, E. M. (2006). Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy, 8(4), 315-317.
7. Teng L, Maqsood M, Zhu M, Zhou Y, Kang M, Zhou J, Chen J. Exosomes Derived from Human Umbilical Cord Mesenchymal Stem Cells Accelerate Diabetic Wound Healing via Promoting M2 Macrophage Polarization, Angiogenesis, and Collagen Deposition. Int J Mol Sci. 2022 Sep 9;23(18):10421. doi: 10.3390/ijms231810421. PMID: 36142334; PMCID: PMC9498995.
8. Wang, Zg., He, Zy., Liang, S. et al. Comprehensive proteomic analysis of exosomes derived from human bone marrow, adipose tissue, and umbilical cord mesenchymal stem cells. Stem Cell Res Ther 11, 511 (2020). https://doi.org/10.1186/s13287-020-02032-8
9. Zhang, N., Zhu, J., Ma, Q. et al. Exosomes derived from human umbilical cord MSCs rejuvenate aged MSCs and enhance their functions for myocardial repair. Stem Cell Res Ther 11, 273 (2020). https://doi.org/10.1186/s13287-020-01782-9
10. Zhang, Z., Mi, T., Jin, L. et al. Comprehensive proteomic analysis of exosome mimetic vesicles and exosomes derived from human umbilical cord mesenchymal stem cells. Stem Cell Res Ther 13, 312 (2022). https://doi.org/10.1186/s13287-022-03008-6
11. Bian, D., Wu, Y., Song, G. et al. The application of mesenchymal stromal cells (MSCs) and their derivative exosome in skin wound healing: a comprehensive review. Stem Cell Res Ther 13, 24 (2022). https://doi.org/10.1186/s13287-021-02697-9
12. Yari, H., Mikhailova, M.V., Mardasi, M. et al. Emerging role of mesenchymal stromal cells (MSCs)-derived exosome in neurodegeneration-associated conditions: a groundbreaking cell-free approach. Stem Cell Res Ther 13, 423 (2022). https://doi.org/10.1186/s13287-022-03122-5
13. Velnar T, Bailey T, Smrkolj V. The wound healing process: an overview of the cellular and molecular mechanisms. J Int Med Res. 2009 Sep-Oct;37(5):1528-42. doi: 10.1177/147323000903700531. PMID: 19930861.
14. Toghiani, R., Azimian Zavareh, V., Najafi, H. et al. Hypoxia-preconditioned WJ-MSC spheroid-derived exosomes delivering miR-210 for renal cell restoration in hypoxia-reoxygenation injury. Stem Cell Res Ther 15, 240 (2024). https://doi.org/10.1186/s13287-024-03845-7