Clinical Evaluation of Exosomes for Treating Low Back Pain: A Comprehensive Review

Low back pain is a widespread issue that affects millions of people worldwide, significantly impacting their daily lives and placing a substantial financial strain on the healthcare system. Existing treatment options for low back pain often provide only temporary relief and come with various limitations. With the increasing interest in regenerative medicine, newer treatments like orthobiologics, including extracellular vesicles or exosomes derived from mesenchymal stem cells, are being explored as potential alternatives for managing musculoskeletal conditions such as low back pain.

As part of this review, Gupta examines the outcomes of clinical studies using extracellular vesicles or exosomes for treating low back pain.

Understanding Low Back Pain

Low back pain is one of the leading causes of disability across the globe, affecting hundreds of millions of people. The condition is expected to increase in prevalence, with estimates suggesting that 843 million people will be affected by 2050. The lifetime risk of experiencing low back pain ranges between 65% and 85%, contributing to over $50 billion in healthcare costs each year.

Several factors can contribute to low back pain, including:

• Lumbar facet joint issues: These joints in the spine can degenerate due to aging, inflammation, or trauma, leading to chronic pain conditions.
• Disc herniation: This occurs when the spinal disc bulges into the spinal canal, compressing nerve roots and causing symptoms such as lumbar radiculopathy (pain radiating from the lower back to the legs).

Traditional Treatments for Low Back Pain

Common treatments for low back pain include physical therapy, chiropractic care, acupuncture, pain-relieving medications (such as narcotics and anti-inflammatory drugs), and minimally invasive procedures like nerve blocks and radiofrequency ablation. Despite their widespread use, these approaches often have limited effectiveness in providing long-term pain relief and may carry side effects. For example, steroid injections—one of the most commonly used interventions—often do not offer significant benefits compared to a placebo.

Emerging Treatments: The Role of Exosomes and Extracellular Vesicles

Recent research has focused on cellular therapies using mesenchymal stem cells (MSCs) due to their ability to regenerate damaged tissues. Extracellular vesicles (EVs), including exosomes, are small particles released by MSCs that play a key role in their therapeutic effects. These vesicles are known to:

• Reduce inflammation: EVs can decrease inflammation by promoting the healing type of immune cells (M2 macrophages).
• Promote tissue repair: They aid in the healing process and have lower risk of immune rejection than the cells themselves.

EVs may overcome some of the limitations of stem cell therapies, such as poor survival and retention at the treatment site, by delivering therapeutic molecules directly to the affected areas. This makes them a promising candidate for treating conditions like low back pain.

Review of Clinical Studies Using Exosomes for Low Back Pain

This review, Gupta looked at studies published up to March 2024 to assess the use of extracellular vesicles and exosomes in treating low back pain. Several databases were searched for relevant studies, including Scopus, PubMed, and Web of Science. The inclusion criteria focused on clinical trials that involved the use of exosomes for low back pain, while studies that did not explicitly use exosomes or were unrelated to low back pain were excluded.

Only two studies met the criteria:

1. Study by Phillips et al.: This research involved administering exosomes derived from bone marrow stem cells to patients experiencing lumbar and cervical radiculopathy (nerve pain in the back and neck). The treatment was found to be safe and showed a reduction in pain and improvement in function at a one-month follow-up.
2. Study by Wilson et al.: In this study, exosomes were injected into the facet joint space of patients with lumbar facet joint pain. The results indicated that the treatment was safe and led to significant improvements in pain relief and function at a three-month follow-up.

These findings align with other literature supporting the potential benefits of using stem cell-based therapies for managing low back pain. The use of exosomes may provide an effective alternative by retaining the regenerative properties of MSCs while avoiding some of the challenges associated with using live cells.

Exosomes: A Promising Treatment for Low Back Pain

Gupta’s review of current studies suggests that exosomes or extracellular vesicles could offer a safe and potentially effective treatment for low back pain. By targeting inflammation and promoting tissue healing, exosomes may provide a novel approach to managing a condition that affects millions of people. However, further high-quality research is necessary to confirm their long-term safety and effectiveness and to understand how they compare to existing treatments.

Source: Gupta A. Exosomes for the Management of Low Back Pain: A Review of Current Clinical Evidence. Cureus. 2024 Apr 3;16(4):e57539. doi: 10.7759/cureus.57539. PMID: 38707134; PMCID: PMC11068073.