Revolution in Regenerative Medicine: Exosomes w/ Dr. Jordan Plews

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Welcome to Park Avenue
Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your co-host, Doreen Wu,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator and technology innovator.

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The title of today's episode is
Revolution in Regenerative Medicine:

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Exosomes. Dr. Bass, we've talked
about regenerative medicine before.

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Where are we going today?

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You're right, Doreen.

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We have focused on regenerative medicine
on a couple of episodes and mentioned

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it in several more.

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That's because it's seen as the future
of the approach to treating many

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degenerative diseases and aging changes.

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I wanted to revisit the subject
and what's happening with exosomes

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specifically. We've talked about
some of the potential benefits,

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but also some of the regulatory
hurdles with stem cells,

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but that's not the whole story.

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One hot emerging area
right now is exosomes.

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What are they? How do they
work? Why are they important?

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I've brought in expert scientists to
discuss what's happening in this space.

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Dr. Jordan Plews is the CEO
and Co-founder of ELEVAI

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Labs,

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which has developed advanced
biologically active skincare for

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anti-aging.

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Dr. Plews studied stem cells and
molecular biology in England and

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completed a PhD in the engineering
doctorate program at University

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College London.

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He studied biochemical engineering
and bioprocess management there,

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and he subsequently completed
a postdoctoral fellowship
and some business school

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training at Stanford University.

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He's conducted extensive research
developing stem cell-based regenerative

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medicine solutions for a variety
of degenerative diseases.

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More recently, he's focused
his work on aesthetic medicine,

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and this summary of Dr. Plews' credentials

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doesn't really explain
the experience and the

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history of his involvement
with stem cells,

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but he's going to have the chance to
explain that himself a little bit during

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this podcast episode.
So Dr. Plews, welcome.

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Thank you for having me.
It's a pleasure to be here.

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Welcome, Dr. Plews. We're
very excited to have you on.

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So before we get to exosomes,

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can you review for us and give us an
overview of the idea of regenerative

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medicine and its potential benefits?

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Yeah, so to me,

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the promise of regenerative medicine
has always been about closing the gap

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between what I think we think of
pharmaceuticals traditionally doing,

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which is often treating the symptoms
with a pill or a drug to really focusing

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on what we can do to treat the problem
at the cellular or molecular level

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to really repair what's going on.
And so in my family, for example,

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my younger brother has type one diabetes,

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I have Alzheimer's that runs with
my family. These are at the core,

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a cellular issue,

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and I think regenerative medicine
has the opportunity to address these

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cellular issues in a way that we just
haven't been able to with single molecule

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drugs.

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That's amazing.

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And Dr. Bass usually gives us a little
bit of a history lesson when it comes to

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the subject we're
discussing in the podcast.

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Can you tell us a bit about
the history behind stem cells?

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Yeah, so there's a lot that has happened.

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I think the earliest I can think of is
all the way back to the work of Gurdon

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in the sixties, and I ended up
playing a role in my doctorate work,

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but I think stem cells really
started to take off and get into the

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public eye in the early 2000s.

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You might remember Dolly the sheep
was born as an initial clone,

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mammal clone in 1997, I think it was 1998,

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that James Thompson first isolated
embryonic human embryonic stem cells.

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And then it was only a few short
years later in 2001 that under Bush,

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a lot of that embryonic stem cell
work was banned in the United States.

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Of course, before that,

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there was some early work on
animal derived as inchy and

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embryonic, but I think
it really got exciting,

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like say in those early 2000s where
initially there was this sort of fear of

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like, wait a minute, we've got
embryonic human stem cells.

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And I was lucky enough to be
in the UK during that time

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where I was able to further the research
where I think in the United States,

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it was a bit on pause
until more work was done.

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And so this actually focused my doctorate
on how can we make a cell that is

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equivalent to an embryonic stem
cell without the use of embryos.

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Dr. Bass was planning on discussing
exosomes in this episode.

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What are exosomes and what kind of
role have they played in the story that

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you're telling about stem cell research?

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So at the most basic level,
it's a message between cells.

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It's one cell sending
another cell a message,

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and I think we have been trying to
capture cellular messages in some

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form or fashion for decades.

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If we focus a little bit on aesthetics,

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I think we really want put youth in a
bottle. That's what it comes back to,

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right? With exosomes, we
have the opportunity to,

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on a cellular level, look at what
the messages are and to some extent,

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potentially control those
messages and provide them in a way

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that we have a little bit more say so.

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Where it relates to stem cells, for me,

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this really kind of, I go back into
my past after biochemical engineering.

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I went to work at Pfizer as part of
their bioprocess development group in

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England, this tiny town
called Sandwich in Kent,

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and they have this big plant there.

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It's mainly making things for
antiseptic during the war.

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Kind of fun anecdote there.

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I learned while I was working there that
mystery mystery was first an antiseptic

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and then it was a floor cleaner before
it eventually became a mouthwash.

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So those of you've had the original
flavor of Listerine might know what I'm

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talking about, and you'd probably go,
yeah, yeah, that probably makes sense.

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Now it's all mint flavored. But
when I grew up, it wasn't that way.

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But ultimately that whole
situation led to me going,

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"we're treating the symptoms here,

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let's treat the problem." And when I got
the opportunity to focus my doctorate

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on stem cell research, I did that.

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And it was like I say all about how do
we create embryonic stem cells without

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using embryos?

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And that really starts with Dolly the
sheep. So another little anecdote here.

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Do you know Dr. Bass where Dolly
the sheep got her name from? No,

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actually I don't. I always tell this
story, I think it's kind of funny,

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but scientists, then they get the
opportunity to name something.

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It's often something a little odd.

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My principal investigator
and the UK for example,

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he loved the Battle of
Trafalgar and Admiral Nelson.

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And so while there's a lot of TRA factors,

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which stands for tumor
recognition antigen,

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he got the opportunity to
name a few trough factors.

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But his TRA is for Trafalgar. And
in the case of Dolly the sheep,

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she was cloned from a
cell in the mammary gland.

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And so he chose a famous person who
was known for her mammary glands

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to name the sheep after.

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So naturally Dolly Parton was the

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inspiration for Dolly the sheep,

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but the importance of Dolly the sheep
was really that it's the first mammal

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that you're starting with a fully adult
cell and you're going all the way back

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to an embryonic state and then going
forward again, and before this,

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it was all on amphibians. And
so when I started my doctorate,

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it was like, okay, what does that guy do?

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And how can we reproduce that because we
don't need to clone to benefit from the

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cloning technology. If I
could take a bit of your skin,

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turn it back into an embryonic state,
and then go forward into brain, kidney,

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liver, et cetera,

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you could basically be your own
donor and you're in effect also

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aging yourselves in that
process, which is exciting.

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So that's really where it started for me.

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And then when I moved over to Stanford,

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it was more about how do we translate
that technology in different ways?

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And that's where I started working more
broadly with other stem cell types and

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where it transitioned to exosomes. The
kind of aha moment for me was we were,

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I should say, my lab in Stanford.

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I was under a principal
investigator named Joe Wu.

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It was a heart lab, a cardiology
lab in the radiology department.

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He's now head of the American
Heart Association, but under them,

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lot of postdocs that were doing things
like injecting stem cells into animal

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models, pig models, dog models,
mouse models, things like that,

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looking at how did stem
cells repair after injury.

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And so in a few of these cases, you
inject the stem cells in into, say,

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the heart of a pig after a heart
attack, and you see some benefit,

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but it wasn't clear what was
coming from. You follow me?

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Yes, I follow you so
far. So the stem cells,

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there was some effect,

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but it's not clear that the
stem cells themselves did it or

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how the repair got mediated,
what the mechanism was.

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Exactly.

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And this is where it gets really
interesting because I think most people

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understand stem cells as a type of
cell that turns into other types of

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cells that differentiates.

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And while that's an interesting
component of stem cells,

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I think what we've found in the last 15,

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20 years is that they're signaling cells,

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that's a big part of what they do is
they're receiving biological information

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and they're sending out
information. And 15 years ago,

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people were saying things
like pericrine factors,

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extracellular vesicles at best,

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most didn't even really fully understand,

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but it was through these
experiments that we realized, okay,

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when you put the cells in,
you're getting a benefit,

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but the cells are not sticking around,
they're not turning into heart cells,

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they're not turning into a cell type
that's fixing or the wound or the problem.

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So what are they doing? And that's
where the aha moment was, Hey,

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these cells are releasing something
and we need to dig into what that is.

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And ultimately, now we
know that as exosomes.

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So the exosomes were the
signal that taught the

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existing cells how to repair.

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In the case of heart cells
after a heart attack,

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what other kinds of
messages can exosomes bring?

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What information is in the exosomes
and how does that interact with the

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cells?

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What's been learned since
then about how exosomes do the

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job and why they might be
a more desirable target

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in all kinds of therapies,

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regenerative therapies
compared to stem cells?

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Yeah, so I think a big
part of this is around,

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we've sort of got to this point
where we know stem cells are

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hugely influential in the body,

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that they play a distinct
role in repair regeneration,

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but ultimately, you can't
put cells in a bottle.

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And to some extent, if
you go and inject them in,

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what you're kind of doing is putting the
factory for these factors wherever you

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want it. But in many cases,
you don't need the factory,

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you just want what it's
producing. You want the exosomes.

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And so for me, it's more about,

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because we know almost all
cells are releasing exosomes,

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all cells are participating in
this messaging back and forth.

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The first question is really,
why do I want a particular cell?

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Why do I want that cell's messages?

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And out of all of the messages it
produces, what are the interesting ones?

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And so slowly but surely,

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that's the path we walk to get to the
stem cells that we use and the exosomes we

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isolate, which I think broadly
we're talking about exosomes today.

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It's one ingredient. It's one thing.
It's a myriad of things really.

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Now I'm wondering what are the
best exosomes and why is it that?

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Yeah, so for me,

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having worked with pretty much every
major human stem cell type from embryonic

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and IPS cells to hemopoietic
stem cells and mesenchymal,

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I've done a lot of work
looking at the various types.

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And you don't generally want to mess
with embryonics for ethical reasons.

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Same with fetal IPS cells
are very interesting,

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but I don't think they're
ready for prime time yet.

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Mesenchymal stem cells
also known as mesenchymal,

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or I should say adult stem cell.

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These are ones that they're very
have a proven safety record.

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These are the ones that exist in your
body and are owning a lot of the repair

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and regeneration.

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And so that naturally was the place
that I was drawn to in order to

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produce exosomes. But more than that,

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if you look at the common
types, you get them from fat,

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you get 'em from bone marrow,
they do exist all over the body,

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even around the edge of the iris in
your eye. But if I had my choice,

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I always wanted to really go
to these age zero stem cells.

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And so that's where we've gone
after the Wharton's jelly,

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which is part of the umbilical cord,

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these Wharton's jelly
mesenchymal stem cells.

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And that's because you're pulling them
from a source that's not tainted by

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environment or diet or any of it with
brains, right? It's arguably the youngest,

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00:14:27,110 --> 00:14:28,270
purest source we can get.

231
00:14:29,500 --> 00:14:34,150
And does that have to do with the
actual message or the epigenetic

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00:14:34,151 --> 00:14:37,720
associated information
with those stem cells?

233
00:14:38,470 --> 00:14:40,030
Yeah, so that's a great question.

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00:14:40,450 --> 00:14:43,510
I think we could do a whole
episode probably on epigenetics,

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00:14:43,511 --> 00:14:47,440
which I think we're finding is more
and more important and is really

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00:14:47,770 --> 00:14:50,200
underlying or underpinnings of aging.

237
00:14:52,040 --> 00:14:56,030
And we can affect our own epigenetics
with our diet, our exercise,

238
00:14:56,300 --> 00:14:57,740
and things that we control.

239
00:14:58,550 --> 00:15:02,300
So in the context of
aesthetics and stem cells,

240
00:15:02,750 --> 00:15:05,270
we're trying to take
these age zero stem cells.

241
00:15:05,271 --> 00:15:10,250
And the real secret sauce is what happens
in the lab where we are provoking or

242
00:15:10,251 --> 00:15:14,990
triggering them to release a message,
an exosome message. And then of course,

243
00:15:14,991 --> 00:15:16,490
they're purifying that out.

244
00:15:17,360 --> 00:15:20,090
And I think talk about
what's the best exosome.

245
00:15:21,080 --> 00:15:25,460
It's starting with the right cell
treated in the right way to get the right

246
00:15:25,470 --> 00:15:26,303
message.

247
00:15:26,630 --> 00:15:30,530
And that's where it's a combination of
the best cell type triggered in the right

248
00:15:30,531 --> 00:15:32,390
way. And then of course from there,

249
00:15:32,391 --> 00:15:37,280
it's about isolating the exosomes and
preserving it in a way that's usable,

250
00:15:38,090 --> 00:15:39,800
which I think is its own challenge.

251
00:15:40,970 --> 00:15:45,110
Okay. So maybe we'll have you back to
talk about epigenetics and other day,

252
00:15:45,111 --> 00:15:49,010
but just to make the distinction clearer

253
00:15:49,880 --> 00:15:54,440
between what exosomes
contain that this is message.

254
00:15:54,441 --> 00:15:59,300
So it's different from
the individual proteins

255
00:15:59,310 --> 00:16:04,310
that the exosomes might hold
the message for it's mRNA that

256
00:16:04,311 --> 00:16:09,140
codes for some kind of protein or
some kind of cellular function.

257
00:16:09,530 --> 00:16:14,210
Can you clarify how that's
different therapeutically than just

258
00:16:14,211 --> 00:16:16,640
dosing someone with the end protein?

259
00:16:17,330 --> 00:16:22,250
Yeah, sure. So to clarify, these
exosomes, they've got a lipid bilayer.

260
00:16:22,610 --> 00:16:26,270
They've got RNA in there, and
that can be in the form of mRNA,

261
00:16:26,271 --> 00:16:28,010
but it could also be in
the form of micro RNA,

262
00:16:28,190 --> 00:16:31,760
which is really an emerging field
still. And you can't have proteins,

263
00:16:31,770 --> 00:16:34,190
you can have proteins in
there. Proteins of course,

264
00:16:34,340 --> 00:16:37,550
is an umbrella term that covers all
the stuff that we usually talk about,

265
00:16:37,551 --> 00:16:41,360
enzymes, cytokines, growth factors.

266
00:16:42,350 --> 00:16:45,590
At its core, a protein is really
just a chain of amino acids,

267
00:16:46,310 --> 00:16:50,180
but oftentimes those chain of amino
acids are folded into something that is

268
00:16:50,190 --> 00:16:55,190
functional. And so I think
as a point of reference,

269
00:16:55,850 --> 00:16:58,850
we are probably all familiar
with growth factor products,

270
00:16:59,060 --> 00:17:03,230
but when you look at how growth factors
are manufactured within the body,

271
00:17:03,231 --> 00:17:04,460
within your cells,

272
00:17:05,780 --> 00:17:08,390
it's not just about having the
right chain of amino acids,

273
00:17:08,400 --> 00:17:12,590
it's about having it folded the right
way with the right glycosylation pale on

274
00:17:12,600 --> 00:17:15,110
it, and basically you end
up with something active.

275
00:17:15,260 --> 00:17:17,600
And what I'm seeing out there,
especially in the aesthetic world,

276
00:17:18,050 --> 00:17:20,630
it's a lot of products
that are made by GMOs.

277
00:17:20,631 --> 00:17:25,580
They've taken a bacteria and then
they've sliced in a piece of DNA to

278
00:17:25,581 --> 00:17:29,120
produce a growth factor. And then they
don't tell you that, oh, by the way,

279
00:17:29,121 --> 00:17:33,920
the bacterial vector that's used, it
doesn't have an endoplasmic reticulum,

280
00:17:33,921 --> 00:17:36,920
it doesn't have a gold golgi
apparatus. So because of that,

281
00:17:37,460 --> 00:17:41,720
you have issues looks folding, you
have issues with no glycosylation tail.

282
00:17:41,721 --> 00:17:46,460
It's literally missing some
of the important things
that are required to produce

283
00:17:46,461 --> 00:17:48,950
the protein in the same
way that your cells look.

284
00:17:49,380 --> 00:17:54,360
And so the benefit of these exosomes is
not only is what's inside of it produced

285
00:17:54,361 --> 00:17:58,140
properly, but it's going to be wrapped
in this protective lipid bilayer.

286
00:17:59,650 --> 00:18:00,900
And as most people know,

287
00:18:00,901 --> 00:18:05,700
if you leave RNA or a growth factor out
on the countertop, it is very unstable,

288
00:18:05,970 --> 00:18:08,340
but within the protection of the exosome,

289
00:18:09,210 --> 00:18:13,710
you can get stability in these unstable
molecules. Does that make sense?

290
00:18:15,600 --> 00:18:18,600
Yeah. So it's kind of
like micro encapsulated,

291
00:18:19,140 --> 00:18:23,210
and it's not just the code for protein,

292
00:18:24,150 --> 00:18:27,810
but it's the biologically
active form of the protein,

293
00:18:28,680 --> 00:18:33,030
or at least the information and
the mechanics to produce that.

294
00:18:34,110 --> 00:18:36,930
Because if you have the
protein, but it's not bioactive,

295
00:18:36,931 --> 00:18:39,840
it's not going to do much good. Now,

296
00:18:39,900 --> 00:18:43,080
I'm curious though how you think,

297
00:18:43,350 --> 00:18:48,030
because I'm old fashioned, the
old fashioned medical training,

298
00:18:48,031 --> 00:18:51,060
you think about medications
in terms of dose.

299
00:18:52,440 --> 00:18:57,180
How are exosomes dosed or how are
they administered in a way that

300
00:18:57,181 --> 00:19:00,960
ensures that they have
biological activity,

301
00:19:00,961 --> 00:19:05,430
that you're getting enough of
them in a functional state,

302
00:19:05,431 --> 00:19:09,870
and how does that compare
with how the body normally

303
00:19:09,900 --> 00:19:14,130
creates its own signaling using exosomes?

304
00:19:15,090 --> 00:19:18,360
Yeah, yeah. So to go back to what
you're saying about micro encapsulation,

305
00:19:18,370 --> 00:19:22,380
I often refer to exosomes as
nature's nano encapsulation.

306
00:19:23,190 --> 00:19:24,120
And so you have to remember,

307
00:19:24,121 --> 00:19:28,140
we're talking about things in this kind
of like 30 to roughly 150 nanometer

308
00:19:28,141 --> 00:19:32,250
range, super, super small, less
than one, 100th, the size of a cell.

309
00:19:33,450 --> 00:19:36,780
But dosage here is a tough one too,

310
00:19:36,810 --> 00:19:38,580
because this,

311
00:19:39,280 --> 00:19:44,130
it's not as though every single
message that one cell sends another

312
00:19:44,340 --> 00:19:47,070
is of a specific dosage or not.

313
00:19:47,280 --> 00:19:50,970
I think what we're actually
seeing is that as our bodies age,

314
00:19:51,420 --> 00:19:55,980
our stem cells are aging with
us and the messages that they

315
00:19:55,981 --> 00:19:59,880
produce are decreasing with age as well.

316
00:20:00,510 --> 00:20:04,500
So it might start off that we're getting
less of the message and then eventually

317
00:20:04,501 --> 00:20:08,430
we have no more of the message being
produced at all. And of course,

318
00:20:08,440 --> 00:20:13,110
some of this is controlled by epigenetics.
I know in the aesthetic world,

319
00:20:13,120 --> 00:20:17,340
we often talk about collagen
and how that degrades over time,

320
00:20:17,341 --> 00:20:22,230
how we go from the state of producing
more collagen than we degrade to

321
00:20:22,231 --> 00:20:24,870
eventually degrading more
collagen than we produce.

322
00:20:25,170 --> 00:20:29,730
And I think we can extend that model
across biology here and say that that's

323
00:20:29,731 --> 00:20:31,470
likely what's happening with exosomes.

324
00:20:32,160 --> 00:20:36,390
And so the way I frame this is more
to think about exosomes perhaps.

325
00:20:36,510 --> 00:20:40,980
Is it like a multivitamin? So
when you take a multivitamin,

326
00:20:41,640 --> 00:20:44,850
your body takes what it needs
and it discards what it doesn't.

327
00:20:45,540 --> 00:20:50,260
And I think right now the field often
focused on what I deem a kind of

328
00:20:50,261 --> 00:20:52,030
American mindset. A bigger is better,

329
00:20:52,031 --> 00:20:56,770
more is better mindset with companies
talking about number of exosomes as

330
00:20:56,771 --> 00:20:58,870
though that relates to dose.

331
00:20:59,290 --> 00:21:03,370
But if you are starting with two different
cell types or two different labs,

332
00:21:03,380 --> 00:21:05,350
treat the same cell type differently,

333
00:21:05,620 --> 00:21:09,790
you can't compare those exosomes number
to number, it's like dollars and pesos.

334
00:21:10,540 --> 00:21:12,490
So when I think about dose,

335
00:21:12,760 --> 00:21:16,990
I think about really we're trying to
give a more balanced message before we

336
00:21:17,110 --> 00:21:20,530
would try to give growth factors. And
some people would say, I'll give you more,

337
00:21:21,190 --> 00:21:22,240
a bigger mix.

338
00:21:23,080 --> 00:21:26,920
But ultimately what we were trying to
do with growth factors is take a part of

339
00:21:26,921 --> 00:21:31,750
that youthfulness message, a part of what
young cells are expressing naturally,

340
00:21:31,960 --> 00:21:36,400
and to put that onto the skin. And I
think what exosomes hold is a broader,

341
00:21:36,520 --> 00:21:40,360
more complete version of that
message that then a more natural,

342
00:21:40,510 --> 00:21:43,150
better protected form.
But at the end of the day,

343
00:21:43,390 --> 00:21:44,920
the skin is still a good barrier.

344
00:21:45,130 --> 00:21:48,340
A lot of what you put onto it is not
going to get all the way to where it needs

345
00:21:48,341 --> 00:21:52,270
to. And this is why we've
developed two products,

346
00:21:52,900 --> 00:21:57,280
both an in-office product that goes
alongside the treatment and an at-home

347
00:21:57,290 --> 00:22:00,520
product so that again, you're
taking this like a multivitamin,

348
00:22:00,790 --> 00:22:04,450
nudging your skin towards
better health each day,

349
00:22:04,630 --> 00:22:09,370
rather than just overloading it
with exosomes at one point in time,

350
00:22:10,480 --> 00:22:12,640
just like eating Thanksgiving dinner,

351
00:22:12,650 --> 00:22:14,260
you're still going to
be hungry the next day.

352
00:22:14,530 --> 00:22:19,330
It doesn't make a lot of sense to just
put the maximum possible at one point in

353
00:22:19,331 --> 00:22:23,800
time as much as it makes sense to use
maybe a lower amount over a longer period

354
00:22:23,801 --> 00:22:25,000
of time. Does that make sense?

355
00:22:25,690 --> 00:22:25,810
Yeah.

356
00:22:25,810 --> 00:22:30,760
And I think that's part of the reason why
this approach is appealing compared to

357
00:22:30,770 --> 00:22:35,260
something like PRP where you
have a whole harvesting process

358
00:22:35,320 --> 00:22:40,090
and you have to be medically
administered to get it

359
00:22:40,091 --> 00:22:41,230
into the skin.

360
00:22:41,231 --> 00:22:45,430
You can't just lalde it on top of the
skin and expect it to do anything,

361
00:22:46,330 --> 00:22:51,280
but you get that one shot at
doing it and then you have

362
00:22:51,290 --> 00:22:55,090
to come back harvest
process again to get more.

363
00:22:57,040 --> 00:22:57,910
To me,

364
00:22:58,390 --> 00:23:02,920
you have much more limited signaling
because you are not getting that micro

365
00:23:02,921 --> 00:23:04,180
encapsulation,

366
00:23:04,420 --> 00:23:09,010
you're not getting the
messaging to the cell to

367
00:23:09,011 --> 00:23:13,960
change. You're getting a single
pulse of a number of growth factors,

368
00:23:14,350 --> 00:23:18,370
a number of chemotactic
agents, that kind of thing.

369
00:23:20,650 --> 00:23:24,760
And so I think this is to my
way of thinking as a clinician,

370
00:23:25,000 --> 00:23:29,830
a next step going forward
that much more effectively

371
00:23:29,831 --> 00:23:34,360
communicates with the cells
we're trying to reach in a way

372
00:23:34,361 --> 00:23:39,190
where the message is
above the threshold of

373
00:23:39,191 --> 00:23:40,180
recognition.

374
00:23:41,560 --> 00:23:45,010
And I think that's part of the confusion
that a lot of folks get into when

375
00:23:45,020 --> 00:23:46,790
they're thinking more is better.

376
00:23:48,260 --> 00:23:53,240
There's clearly a nudge to the
cells that's going to be below what

377
00:23:53,241 --> 00:23:54,950
they might respond to,

378
00:23:54,951 --> 00:23:59,720
and it's probably easier to be below
what they might respond to as our

379
00:23:59,730 --> 00:24:04,460
cells age. But once you've
passed the threshold,

380
00:24:06,110 --> 00:24:10,760
then you sent the message and more
doesn't necessarily make that message

381
00:24:10,761 --> 00:24:11,594
better.

382
00:24:11,600 --> 00:24:16,430
Exactly, exactly. And I have a slightly
different view on PRP personally,

383
00:24:16,580 --> 00:24:21,440
I think about where does
PRP stand in the spectrum of

384
00:24:21,441 --> 00:24:22,160
healing?

385
00:24:22,160 --> 00:24:25,580
And I think there's sort of the four
stage model of healing that's pretty well

386
00:24:25,581 --> 00:24:26,870
accepted academically,

387
00:24:27,170 --> 00:24:31,040
starting with hemostasis moving into
inflammation and eventually to remodel.

388
00:24:31,850 --> 00:24:34,250
And if you look at the cells
that are involved in that,

389
00:24:34,940 --> 00:24:36,920
platelets are in the beginning phase.

390
00:24:36,921 --> 00:24:40,100
They're just right there at the
hemostasis and the inflammation stage.

391
00:24:40,101 --> 00:24:42,710
They don't really play a
role in the later stages,

392
00:24:42,711 --> 00:24:47,210
which are important for healing. And
so when I think about looking at that,

393
00:24:47,540 --> 00:24:50,990
the stem cell actually plays
a role across all four stages.

394
00:24:51,440 --> 00:24:53,930
And I think of platelets as sort of like

395
00:24:55,450 --> 00:24:57,650
they are part of the exosome story.

396
00:24:57,860 --> 00:25:00,560
So when you're pulling blood
and you're preparing PRP,

397
00:25:00,830 --> 00:25:05,720
you're activating those platelets and
there is exosome production by those

398
00:25:05,730 --> 00:25:08,660
platelets. So you have platelet
derived exosomes essentially in there.

399
00:25:09,440 --> 00:25:13,550
But again, you're looking at
what that patient is doing.

400
00:25:13,560 --> 00:25:17,150
So when you're pulling blood from that
patient, how healthy is that patient?

401
00:25:17,480 --> 00:25:22,280
How much of their own biology
has been impacted of an advanced

402
00:25:22,310 --> 00:25:25,220
age? Were they a smoker?
Those sort of things.

403
00:25:27,470 --> 00:25:30,500
So there is an exosome
component to PRP in my opinion,

404
00:25:30,740 --> 00:25:35,450
but most of its job is
to sort of signal the

405
00:25:35,451 --> 00:25:38,000
body to say, the damage is
here, the damage is here.

406
00:25:38,630 --> 00:25:42,140
I've heard some use the analogy
of that kind of Paul Revere.

407
00:25:42,470 --> 00:25:45,800
Others have kind of seen it as sort
of the nine one one phone call.

408
00:25:46,790 --> 00:25:51,650
And that message ultimately is what's
signaling to your stem cells to do the

409
00:25:51,651 --> 00:25:51,981
work,

410
00:25:51,981 --> 00:25:56,420
to come to the site where the damage
is and send the signals or deliver the

411
00:25:56,430 --> 00:26:00,860
signals on how to proceed.
But the problem is as we age,

412
00:26:01,100 --> 00:26:02,750
those stem cells are not getting better.

413
00:26:03,020 --> 00:26:05,960
We're not getting better
at healing as we age.

414
00:26:06,560 --> 00:26:10,520
And by taking exosomes from
these age zero stem cells,

415
00:26:10,760 --> 00:26:15,470
we have an opportunity to
give back to remind yourselves

416
00:26:15,770 --> 00:26:19,820
how to be young again. And I
think that's a powerful thing.

417
00:26:20,600 --> 00:26:21,351
And at the same time,

418
00:26:21,351 --> 00:26:24,740
it's arguably safer than some of
the other approaches we've taken,

419
00:26:24,741 --> 00:26:27,830
which have been up to this point
quite synthetics in my mind.

420
00:26:29,270 --> 00:26:33,980
And I just feel like the breadth
and the durability of the

421
00:26:33,981 --> 00:26:38,570
messaging is much greater than

422
00:26:38,571 --> 00:26:40,100
something like PRP.

423
00:26:41,090 --> 00:26:45,330
For sure. Yeah, the number of
factors by stem cells is much,

424
00:26:45,331 --> 00:26:47,400
much greater than what you're
going to get from platelets.

425
00:26:48,630 --> 00:26:50,160
So the potential there
is of course, higher.

426
00:26:50,970 --> 00:26:53,460
Speaking of the treatment
process, Dr. Plews,

427
00:26:53,461 --> 00:26:57,240
can you tell us about some
of the challenges you've
encountered in harvesting

428
00:26:57,241 --> 00:26:58,074
exosomes?

429
00:26:58,350 --> 00:27:00,300
Oh, yeah. So there's a ton here,

430
00:27:00,330 --> 00:27:05,310
but this is really where I lean on my
background in biochemical engineering.

431
00:27:06,390 --> 00:27:08,490
I think as a biochemical engineer,

432
00:27:08,491 --> 00:27:13,440
you're more or less trained on how
to scale bioprocesses and how to

433
00:27:13,800 --> 00:27:15,720
eliminate inefficiencies.

434
00:27:16,020 --> 00:27:19,230
And so you'll find biochemical engineers
usually working at pharmaceutical

435
00:27:19,231 --> 00:27:20,064
companies,

436
00:27:20,400 --> 00:27:24,990
but also many other places
where filtration isolation and

437
00:27:24,991 --> 00:27:26,160
scale up occurs.

438
00:27:27,090 --> 00:27:32,040
So I've basically taken a biochemical
engineering background and applied

439
00:27:32,041 --> 00:27:35,940
to it, the stem cell knowledge.

440
00:27:36,270 --> 00:27:39,300
And I think most people when they're
taught how to grow stem cells,

441
00:27:39,301 --> 00:27:40,770
how to culture stem cells,

442
00:27:40,771 --> 00:27:44,760
they're taught to do them in a small dish
because the reagents are usually quite

443
00:27:44,761 --> 00:27:45,594
expensive.

444
00:27:46,140 --> 00:27:50,010
So one of the major challenges here is
that we've been able to grow stem cells

445
00:27:50,490 --> 00:27:54,720
at a large scale and therefore produce
exosomes at a very large scale,

446
00:27:55,230 --> 00:27:56,940
rather cheaply.

447
00:27:56,941 --> 00:28:01,770
I don't want to say it's inexpensive
because it's not but much cheaper than it

448
00:28:01,771 --> 00:28:05,940
was before. And I think
also in this regard,

449
00:28:06,150 --> 00:28:10,350
I can't help but mention that we
don't use any animal components,

450
00:28:10,560 --> 00:28:13,320
and that's honestly a
large driver of our cost.

451
00:28:13,330 --> 00:28:17,160
Because if you've ever worked in a lab
anywhere in the world and you've grown

452
00:28:17,161 --> 00:28:18,540
cells, especially human cells,

453
00:28:18,541 --> 00:28:22,920
you've probably encountered something
called fetal bovine serum or FBS,

454
00:28:23,250 --> 00:28:28,080
which is a nutrient rich derivative
of cow blood or calf blood.

455
00:28:28,290 --> 00:28:33,120
But essentially, we don't need to use
that anymore. It's a cheap alternative,

456
00:28:33,121 --> 00:28:37,320
but it carries with it some
of the concerns of animals
in general animal borne

457
00:28:37,321 --> 00:28:41,310
diseases. So when I was studying in
the uk, we had to deal with mad cow.

458
00:28:42,000 --> 00:28:46,830
That still exists. It's also known
as BSE, the prion based disease.

459
00:28:46,890 --> 00:28:49,530
You can't test for it.
You can't filter it out.

460
00:28:50,070 --> 00:28:53,610
It can live in the cow for five years
before they show any symptoms of it.

461
00:28:54,270 --> 00:28:56,670
So rather than take any risk there,

462
00:28:56,910 --> 00:29:01,800
we simply do not use any animal
derived components or animal testing to

463
00:29:02,220 --> 00:29:04,560
get to our products. And I think
that's important going forward.

464
00:29:05,040 --> 00:29:08,400
Most people don't want to buy an aesthetic
product that has anything to do with

465
00:29:08,401 --> 00:29:09,270
animals anyways.

466
00:29:09,720 --> 00:29:12,840
Right? It's just
environmentally friendlier.

467
00:29:12,841 --> 00:29:16,080
It's ethically friendlier
and potentially safer.

468
00:29:16,560 --> 00:29:21,330
Yeah. We also get higher consistency.
Each lot of SBS is different,

469
00:29:21,540 --> 00:29:24,570
so we actually get higher
consistency and safety,

470
00:29:25,080 --> 00:29:28,170
but it does cost us a lot
more money. But in the end,

471
00:29:28,180 --> 00:29:31,260
I think it's something that
everyone should be doing.

472
00:29:32,340 --> 00:29:32,701
Now,

473
00:29:32,701 --> 00:29:36,690
I'm guessing there must also be some
challenges in the delivery of exosomes.

474
00:29:36,691 --> 00:29:38,070
Can you touch on some of those?

475
00:29:38,670 --> 00:29:40,380
Yeah. Honestly,

476
00:29:40,560 --> 00:29:45,520
the biggest challenge is to try to
have people think about things a little

477
00:29:45,521 --> 00:29:46,354
differently.

478
00:29:46,420 --> 00:29:51,190
I think we've traditionally thought
about the skin as this really great

479
00:29:51,191 --> 00:29:53,230
barrier, and not to say it isn't,

480
00:29:53,620 --> 00:29:57,670
but some people treat the skin as though
it's a steel plate with holes drilled

481
00:29:57,671 --> 00:29:59,380
into it of a specific size.

482
00:29:59,710 --> 00:30:03,460
And the reality is that there's
parts that are thinner and thicker,

483
00:30:03,640 --> 00:30:07,540
some that absorbs better than others.
And when you look at the exosome,

484
00:30:08,020 --> 00:30:10,570
we're talking again, 30 to 150 nanometers.

485
00:30:10,750 --> 00:30:15,520
If you compare that to the width
of an average sweat gland or an

486
00:30:15,521 --> 00:30:16,540
average hair follicle,

487
00:30:16,990 --> 00:30:21,820
we're talking about hundreds to thousands
of times larger in diameter than the

488
00:30:21,821 --> 00:30:22,654
exosome.

489
00:30:23,290 --> 00:30:27,700
So exosomes are really throwing a
marble down a well when you look at the

490
00:30:27,701 --> 00:30:30,040
natural porosity of the skin.

491
00:30:31,360 --> 00:30:36,340
So while I think there's
benefits to doing things to open

492
00:30:36,341 --> 00:30:40,750
the skin up, whether
that's microdermabrasion,
microneedling, laser resurfacing,

493
00:30:40,930 --> 00:30:41,763
et cetera,

494
00:30:42,520 --> 00:30:47,020
we are seeing benefits that are
just from topical application.

495
00:30:47,440 --> 00:30:51,400
And this may well be and is likely to
be found to be true hair follicles,

496
00:30:51,401 --> 00:30:52,420
sweat glands, et cetera.

497
00:30:53,290 --> 00:30:57,970
Now, I'm an aesthetic plastic
surgeon, so I have to ask,

498
00:30:58,330 --> 00:31:00,820
just to be sure I'm clear,

499
00:31:00,940 --> 00:31:05,860
what are the specific types
of biological activities

500
00:31:06,310 --> 00:31:10,720
that you think you're modulating
with some of these exosomes?

501
00:31:10,721 --> 00:31:13,540
What things are we
getting the cells to do?

502
00:31:14,920 --> 00:31:18,700
More like youthful skin
and less like aging skin.

503
00:31:20,470 --> 00:31:22,960
So I think everything
that we put onto the skin,

504
00:31:22,961 --> 00:31:27,880
regardless of what product it is,
is having an impact on the skin.

505
00:31:28,480 --> 00:31:32,620
And so over time, we've found growth
factors. We've found hyaluronic acid,

506
00:31:34,840 --> 00:31:36,160
that there's been more recent products,

507
00:31:36,161 --> 00:31:40,270
I think everyone's familiar with
probably TNS Serum by Allergan,

508
00:31:40,271 --> 00:31:44,230
which is a fibroblast
condition media product. To me,

509
00:31:44,231 --> 00:31:48,580
that's arguably the oldest exosome
product on the market, right?

510
00:31:48,581 --> 00:31:50,590
There's probably not a
lot of exosomes in there.

511
00:31:50,591 --> 00:31:53,650
They're probably not very well
protected. But at the end of the day,

512
00:31:53,651 --> 00:31:58,450
we're talking about taking everything
that those cells are releasing and putting

513
00:31:58,451 --> 00:32:02,380
it onto the skin rather than
taking out of that mixture,

514
00:32:02,770 --> 00:32:05,320
focusing on the exosomes,
which is what we're doing now.

515
00:32:06,490 --> 00:32:10,150
And so when you look at what you
would expect to find in there,

516
00:32:10,151 --> 00:32:11,860
you can look at what these cells produce.

517
00:32:12,040 --> 00:32:14,290
So specifically with
mesenchymal stem cells,

518
00:32:14,530 --> 00:32:16,600
they're producing an
array of growth factors.

519
00:32:16,960 --> 00:32:21,400
This is your fibroblast growth factor,
keratin site growth factor, PGF, VEGF.

520
00:32:22,330 --> 00:32:25,870
There's about 20 or so I can
name that, play a role in that.

521
00:32:25,871 --> 00:32:29,320
I think most people understand it's
instinctively the benefits of growth

522
00:32:29,321 --> 00:32:32,920
factors. And I think the word growth
factors is a bit of a misnomer.

523
00:32:33,070 --> 00:32:36,730
It's not always about growth.
It's about healthy cell turnovers.

524
00:32:37,360 --> 00:32:39,980
But then there's also the
usual suspects like collagen,

525
00:32:40,250 --> 00:32:44,780
elastin and other extracellular matrix
proteins that we don't talk about as much

526
00:32:44,781 --> 00:32:46,520
like fibronectin and laminate.

527
00:32:47,690 --> 00:32:51,380
There's also really great antioxidants
that are natural to our cells,

528
00:32:51,381 --> 00:32:52,550
such as SOD2.

529
00:32:54,110 --> 00:32:56,900
This is arguably much
better than vitamin C.

530
00:32:57,570 --> 00:33:00,020
And this is produced
naturally by the stem cell.

531
00:33:00,740 --> 00:33:02,750
The one that I think
is most interesting is,

532
00:33:02,751 --> 00:33:05,750
I don't know if you're familiar with
the work where they were looking at

533
00:33:05,751 --> 00:33:08,210
rodents, I think this was
maybe over five years now,

534
00:33:09,200 --> 00:33:11,780
where they were taking old
rodents and young rodents,

535
00:33:11,850 --> 00:33:15,650
and they put the blood from young rodents
into older rodents and saw that the

536
00:33:15,651 --> 00:33:20,330
older rodents did better in mazes,
did better with their skin and hair,

537
00:33:20,570 --> 00:33:25,280
their metabolism sped up. They were just
all around better. And oddly enough,

538
00:33:25,281 --> 00:33:29,600
when you put the old blood into the
younger rodents, they age faster.

539
00:33:29,960 --> 00:33:32,810
And so if you follow that work through,

540
00:33:33,200 --> 00:33:37,970
there's a factor that's produced by
mesenchymal stem cells called TIP two.

541
00:33:39,080 --> 00:33:43,130
And when that factor was removed, they
no longer saw a lot of these benefits.

542
00:33:43,131 --> 00:33:46,700
So that may well be
part of the driver here.

543
00:33:47,180 --> 00:33:50,660
And then I think what the obvious ones
are things that are what you might call

544
00:33:50,661 --> 00:33:54,920
immunomodulatory factors,
things like interleukins,

545
00:33:54,921 --> 00:33:55,820
interferons,

546
00:33:57,500 --> 00:34:01,190
we talked before the show here about
interleukins and how that's developed over

547
00:34:01,191 --> 00:34:06,140
time. I think we all know instinctively
in the world of aesthetics,

548
00:34:06,150 --> 00:34:10,550
at least that inflammation has its role.

549
00:34:11,180 --> 00:34:13,880
So it's not about shutting
down inflammation actually,

550
00:34:14,120 --> 00:34:18,320
because we're causing controlled micro
injuries with the expectation that the

551
00:34:18,321 --> 00:34:21,260
patient is going to heal up
better than they were before.

552
00:34:21,770 --> 00:34:24,380
But you have to recognize
as part of that process,

553
00:34:24,381 --> 00:34:26,690
we're expecting their body to do the work.

554
00:34:27,110 --> 00:34:30,290
And so all we're really doing
here is supporting that,

555
00:34:31,040 --> 00:34:33,410
that natural recovery and repair,

556
00:34:33,650 --> 00:34:37,100
giving it a bit of a helping
hand by giving it those messages,

557
00:34:37,110 --> 00:34:40,610
those reminders of how to be
young to those older cells.

558
00:34:40,820 --> 00:34:43,490
So while those cells may not be
able to write the message anymore,

559
00:34:43,610 --> 00:34:45,770
they can still read. Does that make sense?

560
00:34:45,920 --> 00:34:49,070
It definitely does. It
makes a lot of sense.

561
00:34:49,071 --> 00:34:53,870
And it's very much that this is a

562
00:34:53,871 --> 00:34:57,140
job that plastic surgeons have
thought about for a long time.

563
00:34:57,141 --> 00:35:00,680
And part of the reason plastic surgeons
have been involved in wound healing

564
00:35:00,681 --> 00:35:04,250
research is the notion of inflammation,

565
00:35:05,330 --> 00:35:07,880
good inflammation and bad inflammation.

566
00:35:08,360 --> 00:35:11,750
It's not that we just want
to upregulate inflammation,

567
00:35:11,930 --> 00:35:14,240
and so we need to heal.

568
00:35:14,241 --> 00:35:18,050
We need to form scar to
repair a wound or an injury,

569
00:35:18,710 --> 00:35:23,600
but there's a point beyond which
that becomes dysfunctional.

570
00:35:23,930 --> 00:35:28,850
And in aesthetic applications in
distinction to reconstructive ones

571
00:35:29,240 --> 00:35:33,410
hitting just the right balance
point is critically important.

572
00:35:34,400 --> 00:35:39,180
And I've heard dermatopathologist
talk about energy-based treatments and

573
00:35:39,181 --> 00:35:41,970
saying, "oh, you're just
putting scar in the skin,

574
00:35:42,330 --> 00:35:47,250
stimulating neocollagenesis as
a healing response." But that's

575
00:35:47,251 --> 00:35:51,210
an oversimplification, and it's
really about the balance point,

576
00:35:51,880 --> 00:35:56,670
because more collagen in your
skin is a good thing if you're old

577
00:35:56,671 --> 00:36:00,150
because you've lost a lot of collagen
in your skin and it's not as well

578
00:36:01,020 --> 00:36:01,853
organized.

579
00:36:01,950 --> 00:36:06,870
But simply putting an uncontrolled amount

580
00:36:06,871 --> 00:36:10,050
in without proper remodeling,

581
00:36:10,980 --> 00:36:14,850
which is that fourth stage of
healing that you alluded to earlier,

582
00:36:14,970 --> 00:36:18,780
is going to be intrinsically
problematic, and it's going to create,

583
00:36:18,781 --> 00:36:21,540
rather than create a
beneficial aesthetic result,

584
00:36:21,780 --> 00:36:25,740
it's going to create something that we
as plastic surgeons would need to come in

585
00:36:25,741 --> 00:36:29,070
and treat as a problem healing response.

586
00:36:30,930 --> 00:36:32,820
So that's really interesting. Now,

587
00:36:33,340 --> 00:36:37,530
I'd like to think for a minute
about your products specifically,

588
00:36:38,220 --> 00:36:42,570
because I'm sure you could
tell us many stories about the

589
00:36:42,660 --> 00:36:45,030
challenges you faced in developing them,

590
00:36:45,510 --> 00:36:48,390
but tell me what kind of
problems you've overcome,

591
00:36:48,391 --> 00:36:52,950
what kind of attributes the
products are able to deliver that

592
00:36:52,951 --> 00:36:55,770
distinguishes them from
what's come before?

593
00:36:56,370 --> 00:36:59,070
Yeah. So before this,

594
00:36:59,220 --> 00:37:02,790
I think the idea was stem
cells are great. I want them,

595
00:37:02,940 --> 00:37:06,780
I want to put them wherever I
have damage. And unfortunately,

596
00:37:06,781 --> 00:37:10,830
most doctors today do not have a stem
cell lab in the back room where they can

597
00:37:10,831 --> 00:37:13,860
prepare these fresh and put them
into the patient. And of course,

598
00:37:13,861 --> 00:37:16,110
there's FDA limitations
around that as well.

599
00:37:16,350 --> 00:37:21,060
What I think that stem cell
exosomes potentially offer is a

600
00:37:21,070 --> 00:37:24,960
bit of that potential in
something we can bottle,

601
00:37:25,080 --> 00:37:29,670
that we can put on the shelf we can
use more easily. And a lot of people,

602
00:37:29,880 --> 00:37:30,713
I think,

603
00:37:31,020 --> 00:37:35,340
have a hard time with this because
they're used to this idea that stem cells,

604
00:37:35,341 --> 00:37:38,730
when you want to preserve them, you got
to throw them into cryopreservation.

605
00:37:39,960 --> 00:37:41,430
But you have to remember these exosomes,

606
00:37:41,431 --> 00:37:45,000
they're being produced right now
in your body at 98.6 degrees.

607
00:37:45,900 --> 00:37:47,010
And if you look at the physics,

608
00:37:47,011 --> 00:37:49,800
which are controlled by an
equation called coer equation,

609
00:37:50,490 --> 00:37:54,960
the smaller the diameter of the
exosome, the stronger it actually is.

610
00:37:55,620 --> 00:37:59,940
And so the idea that
we can provide it in a

611
00:38:00,630 --> 00:38:04,860
room temperature formula actually makes
a lot of sense when you look at it

612
00:38:05,670 --> 00:38:08,010
from that angle, more like
an engineering mindset.

613
00:38:08,790 --> 00:38:13,500
So that's really the first approach is
we saw that there were a lot of exome

614
00:38:13,501 --> 00:38:14,880
products coming to the market.

615
00:38:15,090 --> 00:38:18,510
Most of them were really
designed for injection.

616
00:38:18,750 --> 00:38:21,840
The FDA has been very clear.
You cannot inject these.

617
00:38:22,650 --> 00:38:27,330
And so this is why we've very purposely
focused on topical applications and

618
00:38:27,331 --> 00:38:30,090
getting that formulation,
topical formulation correct.

619
00:38:31,410 --> 00:38:35,590
And ultimately it makes the ease
of use so much better for the of

620
00:38:35,591 --> 00:38:36,490
applications.

621
00:38:36,760 --> 00:38:40,870
And while I'm excited for a future in
which there are some injectable exosome

622
00:38:40,871 --> 00:38:43,420
products, I think the road
to get there is much longer.

623
00:38:43,810 --> 00:38:47,410
And this is a way that we
can benefit from these today.

624
00:38:48,310 --> 00:38:52,360
And they're really just the kind of
the next generation of growth factor

625
00:38:52,361 --> 00:38:55,450
products. So if you're familiar
with our condition media,

626
00:38:55,540 --> 00:38:56,650
our growth market product today,

627
00:38:57,190 --> 00:39:00,340
this is that next generation
on top that's that much better,

628
00:39:00,820 --> 00:39:05,680
not much more complete, really providing
a more complete message of youth,

629
00:39:05,690 --> 00:39:06,523
if you will.

630
00:39:06,940 --> 00:39:11,290
Speaking of the future, what do you think
is coming next? What is your vision?

631
00:39:11,291 --> 00:39:13,990
How will we be using
exosomes going forward?

632
00:39:15,130 --> 00:39:17,860
Yeah, so it's an exciting future.

633
00:39:17,861 --> 00:39:22,780
I think there is a place
for exosomes in a lot of

634
00:39:22,781 --> 00:39:24,220
different areas of medicine.

635
00:39:24,850 --> 00:39:29,530
I think injectables will take some
time to get to where they need to,

636
00:39:30,010 --> 00:39:34,360
but people look at exosomes and a
lot of doctors I talk to say, oh,

637
00:39:34,361 --> 00:39:35,950
this is new. It's unproven.

638
00:39:36,280 --> 00:39:40,240
But if you look on Google Scholar and
just type in human stem cell exosomes,

639
00:39:40,241 --> 00:39:42,070
you'll get over a hundred thousand hits.

640
00:39:43,390 --> 00:39:47,830
And that's not even counting all of
the papers that are about extracellular

641
00:39:47,860 --> 00:39:51,190
vesicles or are reassuring to
exosomes using different wording.

642
00:39:52,090 --> 00:39:56,770
So I think we're a lot farther along
and moving a lot faster than most people

643
00:39:56,771 --> 00:39:58,030
realize. And

644
00:39:59,860 --> 00:40:04,510
what's really interesting for me is
I want to move from this place where

645
00:40:04,810 --> 00:40:08,560
right now we've been focused on what I
would call the hero ingredient model,

646
00:40:08,980 --> 00:40:13,510
where a scientist extracts something
from a plant or derives something

647
00:40:13,511 --> 00:40:17,290
synthetic like a chemical
or puts together a peptide,

648
00:40:17,560 --> 00:40:21,220
and then they build this
whole story telling you how
it's going to do everything

649
00:40:21,230 --> 00:40:22,720
you need. And at best,

650
00:40:22,900 --> 00:40:26,740
we have these products to have a handful
of single molecules that do a few

651
00:40:26,741 --> 00:40:30,700
things very well. When in reality, if
we just go back to the start and say,

652
00:40:30,940 --> 00:40:34,060
what is youthful skin
doing? What's it producing?

653
00:40:34,390 --> 00:40:39,220
And how can we capture a more complete
version of that message that leads you to

654
00:40:39,221 --> 00:40:40,054
exosomes,

655
00:40:40,150 --> 00:40:44,470
that leads you to stem cell exosomes that
leads you to exosomes from very young

656
00:40:44,471 --> 00:40:47,230
skin? There's a variety of ways
you can look at it, but arguably,

657
00:40:47,231 --> 00:40:50,680
we're getting that much closer to
putting youthfulness in the bottle.

658
00:40:51,100 --> 00:40:55,930
And I think we're moving past a
place where doctors were saying, oh,

659
00:40:55,940 --> 00:40:58,750
it's just lotions and potions.
We can't really do anything.

660
00:40:59,140 --> 00:41:00,790
I got to cut to really get something done.

661
00:41:00,791 --> 00:41:03,550
I got to do something physical
to get something done.

662
00:41:03,820 --> 00:41:06,580
I think we are moving past that now,

663
00:41:07,000 --> 00:41:11,290
where I hope that the benefits are clear
here that when you put together the

664
00:41:11,291 --> 00:41:14,470
existing realm of aesthetic
medicine with exosomes,

665
00:41:15,040 --> 00:41:19,840
there's so much more potential what we
can do. And beyond aesthetics. I mean,

666
00:41:19,841 --> 00:41:23,950
we did have a whole nother episode on
what other messages from other cell types

667
00:41:23,951 --> 00:41:26,830
in the body are capable of and how
that's going to impact medicine.

668
00:41:28,090 --> 00:41:33,010
But again, if you pay attention
to the story, it's growing in all.

669
00:41:33,590 --> 00:41:37,070
And I think we're going to be in a very
different world in about 10 years time.

670
00:41:37,910 --> 00:41:42,050
That's very exciting. Lastly, before
we end this podcast, Dr. Plews,

671
00:41:42,260 --> 00:41:44,420
can you share some takeaways
with our listeners?

672
00:41:45,050 --> 00:41:48,770
Yeah, of course. So I think a lot
of people are looking around going,

673
00:41:48,771 --> 00:41:53,510
how do I benefit from this
technology? Today, our products,

674
00:41:54,500 --> 00:41:59,270
labs, products, we are only selling
to dermatologists, plastic surgeons,

675
00:41:59,600 --> 00:42:01,940
and a handful of high-end medical spas.

676
00:42:02,360 --> 00:42:06,050
And really this is because this
is a high education product.

677
00:42:06,440 --> 00:42:09,020
It's not something that's
cheap to make or manufacture.

678
00:42:09,320 --> 00:42:13,820
And so we really are pushing it through
folks that have the right expertise.

679
00:42:14,450 --> 00:42:17,090
But if you are a doctor and you're
considering bringing these on,

680
00:42:17,091 --> 00:42:20,360
or you're a potential patient
that wants to benefit from these,

681
00:42:21,020 --> 00:42:23,900
ask the tough questions.
What is the source?

682
00:42:23,901 --> 00:42:28,580
What is the cell source of the exosomes?
What, who's behind the process?

683
00:42:28,820 --> 00:42:31,880
Do you know anything about that
lab or the person running that lab?

684
00:42:32,510 --> 00:42:34,790
How are they stabilizing packaging it?

685
00:42:35,120 --> 00:42:38,270
Is it really something that's
designed for aesthetic topical use,

686
00:42:38,271 --> 00:42:41,150
or is it really something
designed for injection?

687
00:42:42,200 --> 00:42:46,280
And more than any of these things, I think
for most users and users and doctors,

688
00:42:46,730 --> 00:42:48,020
they want know efficacy.

689
00:42:48,021 --> 00:42:50,150
They want to know that there's
going to be real results.

690
00:42:50,450 --> 00:42:55,130
And so ask the tough questions. Look at
the before and afters, look at the data.

691
00:42:56,720 --> 00:42:58,520
I think we're still in early days,

692
00:42:58,521 --> 00:43:03,440
so most of the exosome companies
only have a few studies that

693
00:43:03,441 --> 00:43:08,210
are published. Some are ongoing. We have
multiple studies and process right now.

694
00:43:09,410 --> 00:43:11,090
But I think, again,

695
00:43:11,540 --> 00:43:15,320
you want to at least make sure that
you see some proof of efficacy.

696
00:43:15,590 --> 00:43:19,880
And again, always depend on
your doctor, your dermatologist,

697
00:43:19,970 --> 00:43:23,930
your plastic surgeon, get their opinion
before proceeding. Unfortunately,

698
00:43:23,931 --> 00:43:26,390
there is still a lot of
misinformation out there,

699
00:43:26,720 --> 00:43:29,630
and we only get past it by
asking the tough questions.

700
00:43:30,740 --> 00:43:32,030
What are your takeaways, Dr. Bass?

701
00:43:32,780 --> 00:43:36,440
Well, I think Dr. Plews gave
us a great summary there,

702
00:43:37,310 --> 00:43:39,800
but I'll just reiterate
a few of the points.

703
00:43:40,580 --> 00:43:45,380
Exosomes teach youthful
biology to aging cells.

704
00:43:46,850 --> 00:43:49,280
They deliver multiple messages.

705
00:43:49,281 --> 00:43:53,120
It's not just a single growth
factor or a single, as he said,

706
00:43:53,121 --> 00:43:54,470
hero ingredient,

707
00:43:54,860 --> 00:43:58,820
and they signal the response
in a more biological way,

708
00:44:01,430 --> 00:44:06,020
they're safe. And this is an
advancement in what we're doing in

709
00:44:06,140 --> 00:44:09,800
skincare that's regulatory compliant.

710
00:44:11,330 --> 00:44:13,790
The right exosomes are really important.

711
00:44:14,600 --> 00:44:17,690
It's not that an exosome is
an exosome is an exosome.

712
00:44:18,380 --> 00:44:23,360
So the notion of zero age
stem cell exosomes seems to

713
00:44:23,361 --> 00:44:25,460
be a very important concept.

714
00:44:26,510 --> 00:44:28,670
And I will always agree,

715
00:44:29,060 --> 00:44:33,210
like most plastic surgeons will
with what Dr. Plews said about data,

716
00:44:34,560 --> 00:44:36,900
everything is about outcome data.

717
00:44:36,901 --> 00:44:41,700
And there are very few skin products
with any data about their efficacy.

718
00:44:41,730 --> 00:44:45,360
But some of the products
do have efficacy data,

719
00:44:45,690 --> 00:44:49,650
and that's critically important to be
assured that they're actually doing

720
00:44:49,651 --> 00:44:51,270
something meaningful.

721
00:44:52,530 --> 00:44:57,330
So exosomes are a big step forward in
meeting the promise of regenerative

722
00:44:57,331 --> 00:44:58,980
approaches in medicine.

723
00:44:59,790 --> 00:45:03,210
And I'd like to thank Dr. Plews,

724
00:45:03,600 --> 00:45:08,460
the CEO and co-founder of ELEVAI
Labs and stem cell researcher for

725
00:45:08,461 --> 00:45:13,440
sharing his fascinating view
of the scientific advances

726
00:45:13,740 --> 00:45:17,970
that are changing our lives. Thank you
for having me. It's been a pleasure.

727
00:45:18,630 --> 00:45:19,590
I'll echo Dr. Bass,

728
00:45:19,710 --> 00:45:23,400
and say thank you to Dr. Plews for taking
the time to come on and share with us

729
00:45:23,401 --> 00:45:26,280
your insight and expertise
about this cutting-edge science.

730
00:45:27,210 --> 00:45:30,930
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

731
00:45:31,290 --> 00:45:32,790
Follow us on Apple Podcasts,

732
00:45:32,850 --> 00:45:34,950
write a review and share
the show with your friends.

733
00:45:35,340 --> 00:45:38,430
Be sure to join us next time to avoid
missing all the great content that's

734
00:45:38,440 --> 00:45:41,940
coming your way. If you want to
contact us with comments or questions,

735
00:45:41,970 --> 00:45:42,870
we'd love to hear from you,

736
00:45:43,380 --> 00:45:47,580
send us an email at podcast@drbass.net
or DM us on Instagram

737
00:45:48,420 --> 00:45:48,510
@drbassnyc.