Feature Article: February 2019 – Exosomes Full-Day Track

AMMG to Feature Full-Day Track on Exosomes, with Noted Faculty

Jeff Morris

Exosomes are tiny, subcellular, membrane-bound vesicles that are released by a wide variety of cell types and cancer cells and that can carry membrane and cellular proteins, as well as DNA, microRNA (miRNA), and various other types of RNA, including mRNA fragments, representative of the cell of origin. These extracellular vesicles were first described as such 30 years ago, and since then have been implicated in cell to cell communication and the transmission of disease states, and explored as a means of drug discovery.

The presence of membranous vesicles outside cells was first recognized 50 years ago, but these were originally assumed to be waste products released via shedding of the plasma membrane. The recognition of what we now call exosomes didn’t come until 1983, from studies on the loss of transferrin during the maturation of reticulocytes into erythrocytes. The concept of “exosomes” originally referred to membrane vesicles obtained from biological fluids following studies that reported the secretion of 50 nm-sized vesicles from reticulocytes, which were associated with the transferrin receptor during the maturation process.

Since then, the term has been loosely used for various forms of extracellular vesicle. In 2013, Randy Schekman, James Rothman, and Thomas C. Südhof were awarded the Nobel Prize in Physiology or Medicine for their discovery of the regulatory mechanism of the main intracellular transport system of the cell, the vesicle transport system. Further study and increasing awareness of the role and function of exosomes have transformed them into a hot topic, attracting the attention of researchers worldwide. They have discovered that exosomes play important roles in many physiological and pathological processes.

Scientific excitement is rapidly increasing over the promising ability for application of exosomes for diagnostic, therapeutic, and regenerative purposes. With that in mind, AMMG has scheduled a full-day preconference track dealing with exosomes on Thursday, April 11th, at the 26th Clinical Applications for Age Management Medicine Conference in Miami, Florida. “Exosomes: The Next Generation of Biologic Medicine” will explore the evidence-based science behind exosomes and their use in a variety of areas in Clinical Age Management Medicine, such as biomarkers, ways of treating disease, and their use as targeted delivery vehicles for therapeutic molecules.

The track has been planned by George Shapiro, M.D., a member of the AMMG Conference Planning Committee who is an Adjunct Assistant Professor of Clinical Medicine at New York Medical College, Valhalla, New York, and Founding Partner of Cenegenics, New York City, one of the most prominent age management practices in the country. Dr. Shapiro, a practicing physician for nearly 30 years, has been a leader in innovative medicine, having patented medical devices as well as explored and innovated new medical protocols. He has long been known as one of New York’s foremost cardiologists, specializing in regenerative medicine and improving longevity, including the genomics of cardiovascular disease and congestive heart failure. Dr. Shapiro was the recipient of the 10th Annual Alan P. Mintz, M.D. Award for Clinical Excellence in Age Management Medicine.

Dr. Shapiro is excited about the potential uses for exosomes, and in putting together the track, he reached out to contacts and colleagues who constitute some of the most prominent and knowledgeable practitioners and researchers in the field. Their combined expertise will provide attendees with a complete picture of the wide range of possibilities for use of exosomes. A large part of that discussion will focus on the connection between exosomes and stem cells, and their use in regenerative medicine. As Michale “Mickey” Barber, M.D., notes, “Recent evidence shows that part of the regenerative potential of stem cells are due to exosomes and their potential for healing through cell to cell communication, regulating inflammation and immune response.” Dr. Barber will present a number of cases in which exosomes are used with platelet rich plasma for erectile dysfunction, as well as post stroke and with other clinical challenges. Similarly, Paul Thompson, M.D., will present “Exosomes Therapy for Erectile Dysfunction,” discussing the state of erectile dysfunction treatment, including how exosomes benefit patients with ED.

Continuing the exosome/stell cell connection, Ian White, Ph.D., the Chief Scientific Officer of IMAC Regeneration Centers, and Chairman of the Scientific Committee of the American Academy of Stem Cell Physicians, will talk about how umbilical cord blood-derived mononuclear cells and MSC-derived exosomes are a potent source of regenerative proteins and RNAs. He will discuss how they can be administered therapeutically in an off-the-shelf manner due to their immune privileged state, and used effectively as a flowable allograft without pathological rejection. And Robert Hariri, M.D., Ph.D., will discuss Clinical Experience Using Cell Therapy Derived From Placental Cells. Dr. Hariri is an Adjunct Associate Professor of Pathology at Mt. Sinai School of Medicine in New York, as well as Founder and Executive Chairman of MYOS Corporation, Co-Founder and Vice-Chairman of Human Longevity, Inc., and Founder and Chairman of Celgene Cellular Therapeutics. He has worked for the past 20 years to transform the field of biomedicine where his discoveries and contributions to the study of stem cells and tissue engineering have sparked the development of nearly all existing stem cell therapies. Dr. Hariri pioneered the use of stem cells to treat a range of life-threatening human diseases, and continues today to make transformative contributions in the fields of immuno-oncology and cell therapeutics along with tissue engineering and functional regeneration. He is widely acknowledged for his discovery of pluripotent stem cells derived from the human placenta, and holds over 150 issued and pending patents for discoveries including placenta-derived stem cells, which Nature recognized as one of the ten most important patent estates in the field.

In yet another area of use connected with stem cells, Jeffrey Weiss, M.D. will discuss Treating “Untreatable” Retinal and Optic Nerve Conditions. He will focus on the Stem Cell Ophthalmology Treatment Study (SCOTS), the largest ophthalmology stem cell study registered with the National Institutes of Health. It utilizes autologous bone marrow derived stem cells (BMSC) in the treatment of optic nerve and retinal diseases, and all patients meeting eligibility criteria and enrolled in the study receive active treatment.

The multiple uses for exosomes is illustrated by the variety of other lectures in the track. Kathy O’Neil-Smith, M.D., will look at exosomes in the literature and review the roles they play in different neurodegenerative diseases. She says that because they are associated with the transport of different cellular entities across the blood-brain barrier, exosomes might be useful for delivering drugs and other therapeutic molecules to the brain. Dr. O’Neil-Smith is an internationally recognized clinician, educator, and consultant in the field of integrative medicine, who is dedicated to offering the most cutting-edge safe therapies to her patients and helping others do the same. And Marvin Sponaugle, M.D., will cover Exosome Therapy for the Treatment of Encephalitis and Autistic Spectrum Disorders. Dr. Sponaugle, who practices in Florida, will present the case of a 22-year-old male who lost his ability to speak at age two and was diagnosed with autism. Through sequential PET scans, Dr. Sponaugle will demonstrate how he was able to reduce brain infection to the point where the patient is now able to speak, and will discuss how the same multiple factors are the causation of both premature dementia and Autistic Spectrum disorders.

Exosomes and Cancer will be the topic of another AMMG Planning Committee member, Edwin Lee, M.D. The founder of the Institute for Hormonal Balance in Orlando, Dr. Lee will discuss the role exosomes play in regards to promotion of tumor growth, tumorigenesis, tumor angiogenesis, tumor immune escape, drug resistance, and metastasis. In addition, he will explore the role of exosomes as a cancer biomarker and how they may become the standard for an early detection or surveillance marker for cancer. Finally, he will discuss the role exosomes have in the future as a cancer therapeutic agent.

Also dealing with cancer, Daniel Sperling, M.D., will present Exosomes Therapy in Combination with Laser Ablation for Prostate Cancer Surgery. The Medical Director and Chief of Interventional Uroradiology at Sperling Prostate Center in Florida and New York, Dr. Sperling is the leading pioneer in image-guided Focal Laser Ablation (FLA) for targeted prostate cancer treatment. He will identify the areas of greatest potential use of exosomes, and explain how exosomes can facilitate healing and boost cancer immunity following Focal Laser Ablation for the treatment of prostate cancer.

Rounding out the wide range of topics associated with exosomes, Exosomes as a Novel Therapeutic Approach in Gastrointestinal Diseases will be presented by Rebecca Murray, APRN, FNP-BC, CDE. An Endocrine Nurse Practitioner at the Institute for Hormonal Balance, as well as Medical Director of Ward-Murray HealthCare Consulting, Dr. Murray will discuss exosomes in the context of the epidemic-rate growth of gastrointestinal diseases, including Crohn’s Disease and Ulcerative Colitis. While current treatments are often not effective and carry an increased risk for early onset cancer, research in the area of exosomes has clarified that these “non cell vesicles” have a beneficial biologic and physiologic function in immune-regulation and inflammation in the autoimmune process. Dr. Murray will review the literature of the beneficial outcomes from the use of exosomes in IBD and autoimmunity and how this knowledge can be applied to the treatment of IBD refractory to other treatment options. Finally, Dr. Shapiro himself will cover Exosomes & Cardiovascular Disease.

For more information on the Exosomes track and the entire Clinical Applications for Age Management Medicine Conference, visit agemed.org/conferences/april-2019.