The Switch to Regenerative Medicine

As the 3rd presenter during the morning session of the American Society for Dermatologic Surgery Meeting, “Emerging Concepts,” Saranya Wyles, MD, PhD, assistant professor of dermatology, pharmacology, and regenerative medicine in the department of dermatology at the Mayo Clinic in Rochester, Minnesota, explored the hallmarks of skin aging, the root cause of aging and why it occurs, and regenerative medicine. Wyles first began with an explanation of how health care is evolving. In 21st-century health care, there has been a shift in how medical professionals think about medicine. Traditionally, the first approach was to fight diseases, such as cancer, inflammatory conditions, or autoimmune disorders. Now, the thought process is changing to a root cause approach with a curative option and how to rebuild health. Considering how to overcome the sequence of the different medications and treatments given to patients is rooted in regenerative medicine principles.

For skin aging, there is a molecular ‘clock’ that bodies follow. Within the clock are periods of genomic instability, telomere attrition, and epigenetic alterations, and Wyles’ lab focuses on cellular senescence.

“We've heard a lot at this conference about bio stimulators, aesthetics, and how we can stimulate our internal mechanisms of regeneration. Now, the opposite force of regeneration is the inhibitory aging hallmarks which include cellular senescence. So, what is cell senescence? This is a state that the cell goes into, similar to apoptosis or proliferation, where the cell goes into a cell cycle arrest so instead of dividing apoptosis, leading to cell death, the cell stays in this zombie state,” said Wyles.

Senescence occurs when bodies require a mutation for cancers. When the body recognizes there is something wrong, it launches itself into the senescent state, which can be beneficial. Alternatively, chronic senescence seen with inflammageing, like different intrinsic markers, extrinsic markers, and UV damage, is a sign of late senescence. Senescence cells can be melanocytes, fibroblasts, and cells that contribute to the regeneration of the skin.

“I think we’re in a very exciting time of innovation and advancements in medicine, which is the meeting of longevity science of aging and regenerative medicine,” said Wyles.

Regenerative medicine is a new field of medicine that uses native and bioengineered cells, devices, and engineering platforms with the goal of healing tissues and organs by restoring form and function through innate mechanisms of healing. Stem cell therapy and stem cell application are commonly referenced with regenerative medicine. Typically, first-in-class treatments include cells, autologous or allogeneic, different types of cells that are associated with high-cost due to the manufacturing.

“With regenerative medicine, there's a new class of manufacturing. Regenerative medicine is not like traditional drugs where every product is consistent. These are cells, so the idea of manufacturing, and minimally manipulating, all comes into play. Now, there's a new shift towards next-generation care. This is cell-free technology. So, this is the idea of exosomes, because these are now products from cells that can be directly applied, they can be shelf-stable, accessible, and more cost-effective,” said Wyles.

Exosomes are the ways that the cells communicate with each other. Cells have intercellular communications and depending on the source of the exosomes, there can be different signals. Wyles focused specifically on a platelet product, which is a pooled platelet product that can be purified and used for different mechanisms including wound healing, fat grafting, degenerative joint disease, and more. In a cosmetic study conducted by Mayo Clinic, a topical platelet exosome product was applied to the face in the morning and the evening. Application included a 3-step regimen, a gentle cleanser, a platelet exosome product, and then a sunscreen.

After 6 weeks, there was a significant improvement in redness and a 92% improvement in the hemoglobin process. Vasculature also improved across age groups. The study enrolled 56 patients, and the average age was 54. Patients in their 40s, 50s, and 60s saw consistent improvement in redness and skin aging.

Lastly, Wyles stressed that as dermatologists think through the science-driven practices of these innovative strategies for skin aging, wound healing, and other regenerative approaches, they must think about responsible conducts of research. Currently, there are no FDA indications for exosomes being injected.

Reference:

1. Wyles S. “Targeting hallmarks of skin aging with regenerative medicine: a new frontier in dermatology.” Emerging concepts. Presented at: 2022 American Society for Dermatologic Surgery, Denver, Colorado, October 7-10, 2022.