Exosomes vs PRP vs Stem Cells vs Vsels: What's the Difference?

In these past few years, stem cells, PRP (platelet-rich plasma) and exosomes have been hot topics among researchers and doctors. However, these forms of treatments are often mixed up and are confusing for most average consumers. 

Regenerative medicine is also becoming a buzzword in the medical community. Why? Because the human body is specially equipped to heal itself, and regenerative therapies tap into this powerful ability.

Regenerative medicine includes treatments like stem cell therapy, exosome therapy and platelet-rich plasma (PRP) therapy. Research around these therapies is expanding every day and it's not easy to keep updated.

We will cover the essentials, differences and explain about each of these biologics below.

What is Exosome?

An exosome is a small vesicle produced by a cell that can tell other cells what to do. Exosomes are how cells talk to each other (R).

Put more simply, exosomes are how cells communicate. For example, we can communicate by writing small notes to each other electronically, otherwise known as email. Exosomes are a way for one cell to email another. The message may be how to behave or what’s happening in the local area.

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Intercellular communication through exosomes appears to have a role in the causes of a variety of diseases, including cancer, neurodegeneration, and inflammatory diseases.

There are at least a few hundred different types of exosomes that can all do different things (R). The main challenge is that no one is absolutely clear on how to isolate specific exosomes that code for specific actions like fixing your cartilage, ligaments, tendons, muscles, or nerves. In addition, not all exosomes are helpful. For example, two exosome types have been identified that are associated with a higher death rate in hospitalized patients (R).

What is PRP?

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PRP stands for platelet-rich plasma. Our blood contains small solid components (red cells, white cells, and platelets). Platelets are best known for their role in blood clotting. Platelets also contain hundreds of proteins known as growth factors, which are critical for injury healing.

PRP is plasma that contains much more platelets than normal blood. As a result, PRP is thought to hasten the healing process.

To develop a PRP preparation, blood must first be drawn from a patient. During the centrifugation process, platelets are separated from other blood cells and their concentration is increased. After that, the platelets are injected into the injured area.

The idea is that injecting PRP into damaged tissues will stimulate your body to grow new, healthy cells and promote healing. Because the tissue growth factors are more concentrated in the prepared growth injections, researchers think the body’s tissues may heal faster. Famous athletes like Tiger Woods and tennis star Rafael Nadal have been known to use these injections to help heal injuries.

What are Vsels?

Among the more exciting antiaging therapies now available is Very Small Embryonic-Like Stem cells (Vsels). Vsels are so small, they're easily transported through the lung capillary, so if you were to get an injection of them, they can spread to the rest of your body without being broken down or distorted.

The idea behind VSELs is that they are small and like embryonic stem cells, they can differentiate into many different cell types. They are supposed to be produced largely in the bone marrow but can mobilize from there into the blood under certain circumstances.

It is thought that VSELs originate from the early cells in an embryo and are deposited in developing organs as the embryo grows. It’s also thought that they play a role as a backup population for tissue-committed stem cells. There are stem cells that live in all of your organs that help repair things. So the idea would be that if the local stem cells were depleted or couldn’t function, VSELs would step in.

Importantly, Vsels are also pluripotential, meaning they can differentiate into almost any tissue in your body, whereas mesenchymal stem cells don't have as much differentiation capacity. 

Vsels are taken from your peripheral blood (similar to PRP), can be activated and then guided to the appropriate target area. No surgery is required and the procedure roughly takes 90 minutes to perform (R). Preliminary research is showing that the procedure may also have anti-aging effects by showing reductions in intrinsic and extrinsic age-related factors as documented through epigenetic testing.

What are Stem Cells?

The primary purpose of stem cells is to maintain, heal and regenerate tissues wherever they reside in your body. This is a continuous process that occurs inside your body throughout your life. If you didn’t have stem cells, your lifespan would be about an hour, because there would be nothing to replace exhausted cells or damaged tissue. In addition, any time your body is exposed to any sort of toxin, the inflammatory process causes stem cells to swarm the area to repair the damage.

Stem cells differ from other kinds of cells in the body. They are special because of their ability to self-renew, duplicate, regenerate and repair.

If you are new to stem cells, check out stem cell basics.

Stem cell treatment, also known as regenerative medicine, uses stem cells or their derivatives to promote the repair response of damaged, dysfunctional, or wounded tissue. It’s the next step in organ transplantation, and it relies on cells rather than donor organs, which are in short supply.

In a lab, researchers grow stem cells. These stem cells are manipulated to specialize into specific types of cells. And then the specialized cells can be implanted into a person. For instance, if the person has heart disease, these cells could be injected into the heart muscle.

Exosomes vs Stem Cells

Unlike stem cell therapy, exosome therapy doesn’t involve using donor cells in your body. Instead, exosomes are extracted from donated human mesenchymal stem cells (MSCs) and sterilized.

The exosome solution contains valuable lipids, messenger-RNA, micro-RNA, signaling cytokines, and proteins. Exosome therapy can be administered through intravenous (IV) therapy or direct injection in the treatment area.

Exosomes are powerful elements that can restore cells throughout your body. They enhance cell-to-cell communication, which is essential for overall cell health.

Compared to adult stem cells, exosomes contain nearly three times the amount of growth factors. More growth factors means a better ability to restore and revitalize target cells.

PRP vs Stem Cells

The major advantage of the use of PRP (Platelet Rich Plasma) for therapeutic applications is the immediate preparation of PRP, which does not require any preservative facilities. PRP is considered safe and natural as the preparation involves using own cells without any further modifications.

Although Stem Cells (SC) have added advantage over PRP-based approach in regenerating the damaged tissue, there are certain concerns in using SC for therapies. SC propensity toward self-renewal and differentiation is highly influenced by their local environment making it difficult to interpret how a population of culture expanded stem cells may behave in the human body. Isolation and characterization of SC are crucial and even the isolated SC may have low survival rates. Culturing of SC without contamination requires highly experienced personnel and sophisticated laboratory settings. The chances of microbial contamination of SC might result in complications, especially in those patients whose immune system is compromised. Careful monitoring and observation of this cell-based therapy are of paramount importance, since evidence has shown that fat-derived MSCs (mesenchymal stem cells) have lost genetic stability over time and were prone to cancer formation (R). Furthermore, SC-based therapies require regular follow-up to monitor regenerated tissue over a period of complete recovery of a patient.

A study concludes both intra-articular platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) injections are effective in patients with mild to moderate KOA (knee osteoarthritis) in terms of providing symptomatic relief, restoring physical functionality and improving potential tissue repairment in the affected joints.

PRP treatment works best among patients with KOA Kellgren-Lawrence (KL) grade I-II, while MSCs treatment works best among the KOA KL grade II-III group. Both treatments show minimal effects in patients with severe KOA of KL grade IV.

PRP vs Stem Cells vs Exosomes

For peripheral mild to moderate tendon injuries (partial shoulder rotator cuff tears, shoulder labral tears, tennis/golfer’s elbow, carpal tunnel syndrome, mild hip osteoarthritis, hip labral tears, gluteal or hamstring tears, trochanteric bursitis, mild knee osteoarthritis, mild meniscal tears, ankle ligament sprain, plantar fasciitis and others), platelet-rich plasma is usually a good alternative of treatment. The ease of collection and lower cost are advantages. The need for repeated treatments is somewhat of a disadvantage.

If the injuries or osteoarthritis are severe, then stem cells are a better alternative. One advantage of stem cell therapy is the treatments required are less, and potential drawbacks are the cost.

The age of the patient determines whether patient’s own stem cells are used or not. After age 45, the number of stem cells in bone marrow decreases rapidly every year. The general health of the patient also contributes to the number and quality of stem cells in their tissues.

For a patient who is 50 years old or older, while PRP could be useful, a decision on whether internal sources of stem cells or external sources of stem cells (commercially available regenerative cells derived from healthy donors) to be used will need to be considered.

There is a plethora of these commercially available products, ranging from growth factors derived from placental tissues (umbilical cord blood, amniotic fluid, Wharton’s jelly, etc) to stem cells derived from donors. 

Exosomes are the result of a purification process of stem cells. The result is a concentration of proteins, messenger RNA (mRNA) and growth factors, without any of the original cell’s DNA. The lack of DNA makes rejection of these cells impossible so it lowers the risk of their use.

Therefore, for an older patient with moderate osteoarthritis, a combination of patient’s own PRP and commercially available exosomes might be a viable and balanced option.

Exosomes can be successfully isolated and purified from human PRP

The exosomes derived from PRP (PRP-Exos) have been proven to encapsulate principal growth factors from platelets. According to a study, these exosomes may have the same function as PRP. PRP-Exos can promote angiogenesis and re-epithelialization in chronic wounds by causing endothelial cells and fibroblasts to proliferate and migrate.

A study observed the cutaneous healing process in chronic wounds treated with PRP-Exos in a diabetic rat model. They provide evidence of the probable molecular mechanisms underlying the PRP effect on healing of chronic ulcers and describe a promising resource of growth factors from exosomes without species restriction.

Combinational therapy using both PRP injections and stem cell therapy

PRP and Stem Cell (SC) therapy is continuously studied for their regenerative benefit in wound healing, sports medicine and chronic pain treatment. Although their preparation, mechanism and action and efficacy have been shown to be different, studies have shown that both PRP and SC can complement each other and might have an added advantage when used in combination (R). 

For example, PRP offers a suitable microenvironment for Mesenchymal Stem Cells (MSCs) to promote proliferation and differentiation and accelerates wound healing capabilities. Conversely, PRP can be a powerful tool to attract cell populations, such as MSCs, a combination of which provides a promising approach for the treatment. Some of the common injuries that are treated using combinational therapy include – tendonitis, rotator cuff tears, osteoarthritis, spine conditions, arthritic joints, overuse injuries, inflammation from herniated disc and others.

PRP, Exosomes, and Cartilage Repair

Can the exosomes found in PRP repair cartilage by themselves? Researchers in Asia (R) made PRP and then also isolated the exosomes from PRP. They exposed both mixes to cartilage cells and looked at things like cell growth, the ability to close a tear or gap, helping cartilage cells deal with bad inflammation, and resisting apoptosis (cell death). The PRP and the PRP-derived exosomes without platelets performed similarly. Interestingly, the exosomes did better in some tasks, but that result should be taken with a grain of salt as the exosomes were more concentrated than those found in the PRP sample. 

Exosomes vs PRP Treatment for Hair Loss

Exosome and Hair Restoration | Source: taylorplasticsurgery.com

Both PRP and Exosomes, when injected into the scalp, can make our hair healthier and thicker. Exosomes, on the other hand, are a newer therapy option for hair loss that many researchers suggest is just as effective as or perhaps more effective than PRP.

Exosomes contain some 200+ growth and re-growth factors. They’re recognized for promoting healing, assisting in the regeneration of normal tissue, and a variety of other uses, including hair thickening.

Take Home Message

It is beyond the scope of this article to describe exactly which treatment is better for which condition. Each patient should be treated like an individual and each treatment should be personalized. The choice of regenerative cells is highly individualized based on age and health of the patient and the extent of injury or degeneration. 

Ultimately, nothing can substitute a thorough evaluation, history, physical examination and a diagnostic work-up. We hope that you keep these things in mind when you seek regenerative treatments anywhere.

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