Stem Cells, Exosomes & Platelet Rich Plasma (PRP)

What’s the Difference?

Platelet Rich Plasma Injections (PRP)

Regenerative Medicine started with Prolotherapy (Proliferative Therapy) using dextrose (simple sugar that is made from corn and is chemically identical to glucose, or blood sugar) to create a controlled inflammatory response. In addition to helping heal tendons and ligaments, prolotherapy has been shown to be chondrogenic (has the ability to grow new cartilage in the knee Over a period of roughly 60 years it was recognized that blood platelets entering tissue, after injury release growth factors which activate your body’s own biologic mechanism, the inflammatory or healing process will cascade.

When injected into joints and tissues platelet rich plasma turns on this innate biologic mechanism giving the body a second chance to heal damaged, or insufficient tissues. This area of regenerative medicine is now well established and is taught at Harvard Medical School and over 40 other medical residency programs in the United States.  

Mesenchymal Stem Cells (MSCs)

In time it was recognized PRP also activated local mesenchymal stem cells which were senescent or “asleep” in areas of degeneration or chronic injury. Once activated, these cells have the ability to influence tissue repair.  As scientists and physicians began to inject these cells, the theory was that they differentiated or turned into the cells needed to repair the local tissues. It was later determined that the injected cells died or left the areas in which they were placed. Of note, mesenchymal stem cells (MSCs) have the ability to differentiate into cartilage, tendon, ligament and bone. Hematopoetic cells from bone marrow regenerate blood vessels and immune cells. It is now recognized adipose (fat) from the patient or umbilical (not from self) are the best source of MSCs. So, why were the outcomes better with the injection of MSCs? Why did more patients respond to the combination of PRP and MSCs? 


It was determined MSCs injected into the joint or tissues begin receiving chemical messages about the local environment, and in that case, a local unhealthy environment. MSCs then react by releasing exosomes to activate, or wake up, local senescent Stem Cells which together begin to direct the cellular activities involved in healing.  It is the exosomes that are the actual directors of the healing response, initiated by the new cells injected into the area and then the local cells begin to take over as the injected cells begin to die off or leave the area. The cells that leave the area can then travel to other tissues in need of their services. 

Some physicians are now injecting MSCs and Exosomes intravenously and into or around the central nervous system for neurodegenerative conditions like Alzheimer’s, Parkinson’s, concussion/TBI and stroke recovery. An emerging theory is that these therapies may have the ability to slow the process of aging in all areas of the body. 

So, what does a physician inject? I like to think of Mesenchymal Stem Cells as more personalized. They sample the area and determine what type of exosomes to release. However, when injecting MSCs we can only inject 1-2 million umbilical (young healthy) to 40 million autologous (from the patient). On the other hand, Exosome injection is the equivalent of 10-100 billion MSCs exosomes. At this point we still don’t know what is better. The best option might be both. Although for many this may seem non-precise, this form of medicine is gaining momentum and acceptance. Physicians working at medical schools throughout the country are beginning to practice regenerative medicine.  This area of medicine that has very little risk and has the potential for profound change. 

Bend Regenerative Medicine with Dr. Payson Flattery is leading the regenerative medicine movement in Central Oregon region as the region’s most experienced physician and expert in the subject, as he introduced it to the region in the early 2000s. He’s treated thousands with PRP and Stem Cell Therapies and most recently introduced to the practice the latest technology with Hyperbaric Oxygen Therapy