Exosomes vs PRP Therapy vs Stem Cells: What's the Difference? (2024 Edition)

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. 

As of July 2024, there are more than 300,000 studies related to "stem cell", more than 30,000 studies published related to exosome and more than 14,000 studies related to PRP on PubMed (US NIH Library of Medicine Database). 

Nevertheless, stem cell, PRP and exosome-related therapies are not yet established as standard treatments, given their relatively recent emergence.

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.

The exosomes market size was valued at USD 250.8 million in 2022 and is expected to reach USD 3.2 billion in 2032 with a CAGR of 29.9% from 2023 to 2032 (source). 

Meletios Verras/Shutterstock

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. 

Note: The FDA first allowed the study of botulinum toxin’s effect on health conditions more than 50 years ago. Decades later, it was studied, then approved, as a treatment for wrinkles; today, Botox is possibly the most popular aesthetic procedure worldwide. It takes significant time to understand what innovative treatments are capable of and even longer to get them regulated and approved as an actual therapy. So when the FDA issued a warning letter against exosome treatment in 2019—many aesthetic providers took it with a grain of salt. 

A 12-week Prospective, Double-blind, Randomized Controlled Trial (Acta Derm Venereol 2020) concluded that the combined use of Human Adipose Tissue Stem Cell-derived Exosomes and Fractional CO2 Laser for Acne Scars would provide synergistic effects on both the efficacy and safety of atrophic acne scar treatments.

What is PRP? 

PRP is an abbreviation for Platelet Rich Plasma. It is a substance that’s thought to promote healing when injected. Plasma is a component of your blood that contains special “factors,” or proteins, that help your blood to clot. It also contains proteins that support cell growth. Researchers have produced PRP by isolating plasma from blood and concentrating it.

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.

Related: PRP Knee Treatment Cost 

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

What is the difference between stem cell vs PRP? 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.

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 vs Stem Cells vs Exosomes in Joint Injuries

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.

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. 

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 vs PRP in Chronic Wounds

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.

Exosomes vs PRP for Cosmetic Treatments

Exosome vs PRP, what's the difference? Are they the same in terms of effectiveness and safety for cosmetic treatments?

PRP are not necessarily as potent as exosomes. “Exosomes are vesicles that cells use for communication,” explains Dr. Marina Peredo, a board-certified dermatologist in New York City. “They’re not cells but tiny little bags with all the ‘goodies.’” Platelet cells are actually a common source for the exosomes used in aesthetics treatments, as are placenta and stem cells, but all cells have exosomes—they’re essential messengers that tell cells what to do. “Until about 15 years ago, people thought that exosomes were kind of like the sewer system of the cell, a way to get rid of waste material,” explains scientist Dr. Sanjay Batra, founder of WeThrivv and a former adjunct professor at the Wake Forest Institute for Regenerative Medicine. “No one had any idea that these exosomes are chockfull of pixie dust and magical materials, including growth factors, mRNA, RNA, and things that could influence cell-to-cell communication.”

You may find providers using exosomes as a replacement for—or in conjunction with—PRP. “They have more regenerative potential than PRP, which contains 8 to 10 growth factors. Exosomes contain over 100 different growth factors,” says Dr. Jessie Cheung, a board-certified dermatologist in Chicago who specializes in regenerative medicine. Because they aren’t tied to any specific type of cell, they will send signals to cells in the treatment area to kick things into high gear. “They will wake up cells, keratinocytes and melanocytes and promote new collagen production,” to name a few, explains Dr. Peredo.

How do exosomes work in cosmetic treatments?

Though exosomes are very small, they cannot penetrate and will not be effective when administered to intact skin. They must be applied to skin that has been injured in some way. 

Dr. Marina Peredo, a board-certified dermatologist in New York City often uses exosomes after Clear + Brilliant or RF microneedling. “[After treatment], the skin is normally red and burning,” she says. She then applies the exosomes, which must be refrigerated (more on this shortly); this instantly cools the skin down and causes redness to subside, expediting the healing process.

Brittany Blancato, a medical aesthetician working for New York City-based board-certified facial plastic surgeon Dr. Yael Halaas, has performed exosome treatments on many clients’ skin, including a scar on someone’s chin. “I did microneedling twice, with exosomes topically afterward, and the results were amazing,” she says. “The discoloration is pretty much gone.” Dr. Jennifer Levine, a board-certified facial plastic surgeon in New York City, recounts one patient who had a travel-related injury that wouldn’t heal after six weeks. “I gave her the exosomes, and when I saw her again four days later, it was almost healed,” she says. “They really work.”

It’s the combination of three different factors that seems to be behind the efficacy of exosomes. Though more research is needed, a study from 2021 shows that they stimulate collagen synthesis, reduce inflammation, and promote angiogenesis, the formation of new blood vessels. These characteristics make exosomes an exciting option for treating not just skin health but hair loss too. “I see more hair growth with a single session of exosome therapy than with PRP,” says Dr. Cheung. Similarly, Dr. Halaas’s patients have impressive results, with one showing significant regrowth three months after just one injectable treatment with exosomes.

It’s worth noting that exosomes are also being used intravenously for pain management. Considering that the FDA has not approved any use of exosomes, let alone this therapeutic or drug-like use, this is especially controversial.

What are the differences between all the exosome products available?

There are a lot of exosome brands on the market, including Kimeravive, Benev, Exocel Bio, and Rion. Hydrafacial even also announced in September 2022 that the company plans on releasing an exosome booster sometime this year. The primary differences between these manufacturers’ exosomes are the concentration (or number) of exosomes in the end product and the source of the exosomes themselves.

When used intravenously, there can be several hundred billion exosomes in a single milliliter of product. Injected forms of the treatment use fewer, and topically applied formulas require even fewer to be effective. This is a good thing, as the higher the concentration, the more expensive the treatment. “For topical use, the concentration would be anywhere from 5–25 billion exosomes per mL,” says Dr. Peredo. “If you’re just treating the face, you use one to two mLs; if you do face, neck, and chest, then you probably use five.”

Perhaps obviously, all exosomes are derived from human sources. One common source is mesenchymal stem cells, cells that are capable of self-renewal. “Mesenchymal stem cells are [often] derived from the umbilical cords or amniotic fluid from healthy donor pregnancies,” says Dr. Cheung. They’re also taken from placenta. “Normally, the placenta is discarded,” points out Dr. Peredo. “When you take PRP from someone in their 60s and 70s, the growth factors and platelets are old. When you use exosomes, you inject something that’s very young, like placental cells from a 20-year-old.” However, Dr. Batra notes that the benefits of PRP aren’t often related to age. “Younger patients with younger platelets didn’t always have the best result,” he says. “Remember, a platelet only lives for about seven days, so your body is constantly making new platelets.”

Platelets are another common source of exosomes; platelet-derived exosomes are used by Rion, which in addition to distributing exosomes for clinical use also offers an at-home skin-care collection, ( plated ) Skin Science. These products are formulated with what the brand refers to as platelet extract. This differs from true exosomes—that’s because exosomes are from live cells. “Exosomes are very difficult to keep viable at room temperature, so the products we have either require storage in a special deep freezer and need to be defrosted before use or need to be kept refrigerated and then reconstituted before use,” explains Dr. Cheung.

Anything with true exosomes will not be very shelf stable and will have a short lifespan. Dr. Levine actually whips up exosome-infused Aquaphor for her patients, especially those who have received ablative laser treatment. “We’ve given it to people to heal after procedures, and it works really, really well,” she says. “We tell them to keep it in the refrigerator, keeping it for no more than two weeks.”

Dr. Batra explains that ( plated ) Skin Science formulas are platelet-derived exosomal products for topical use. “It’s what the exosomes release, the payload of what is in the exosomes—proteins and growth factors,” he says. “These proteins are dead. I hate to say it that way, but they still may have a biological effect or improve the appearance of fine lines and wrinkles.” (If you’re familiar with SkinMedica TNS Advanced+ Serum, which use growth factors, it’s a similar concept.)

Are exosomes safe?

The short answer is yes, with the longer answer being that the scientific community isn’t so sure yet, due to limited information. “The real workhorse in regenerative medicine is exosomes,” says Dr. Batra. “They can affect intercellular communication in a really special way. I think it’s very promising. There’s tremendous excitement in the hair world and dermatology.”

It’s worth considering some of the common potential fears of being treated with exosomes. One such concern is that your body could reject them. That’s why, when you get PRP, it has to be sourced from your own body—if a foreign cell is incompatible with your body, your immune system will attack it. Remember though: exosomes are not cells, which is why these little messengers can be extracted from various sources and used by anyone to treat a broad range of concerns.

Another concern is the health or safety of the sourced material—what if the exosomes are pulled from someone with a serious medical condition? That shouldn’t be a worry either. “The manufacturing process essentially purifies the product,” says Dr. Batra. “I don’t worry about taking someone’s blood product—it’s sort of like vodka. When you start distilling vodka, it ends up being very pure. “You want products with detectable RNA and clinical studies, and you need to consider the tissue source,” says Dr. Cheung.

The real question with exosome safety has to do with your own health. “Exosomes are ways that the cells communicate with each other—if information is telling them to make the body do good things, that’s great,” says Dr. Levine. “But what if there’s a bad cell in your body? In someone who might be predisposed to having a disease, can this magnify it? That’s the flip side of the coin.” While there’s no data to show that exosomes do this, the FDA is saying that the knowledge just isn’t there yet—hence the aforementioned warning letter.

But plenty of experimental and well-regarded aesthetic treatments are not cleared by the FDA—including PRP. “The FDA doesn’t govern the practice of medicine, so a physician can give treatments that are considered off label,” says Dr. Batra. Currently, the FDA has approved the use of PRP only in wound care; using it for facials or hair growth is off label. It takes hundreds of millions of dollars, in-depth studies, and often, decades to achieve FDA approval. In the meantime though, providers are going to continue to treat their patients with cutting-edge exosomes—whether you’re excited to join the experiment is up to you.

Take Home Messages

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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