Exosome Evidence Index

The studies

Each entry gives the design, the number of people, where the vesicles came from, how they were given, what the authors found, and what limits the result. Strongest designs are listed first.

How to read the bars and marks

Bars: how strong the study design is

More filled bars means a design that can tell more reliably whether the treatment caused the result.

  • Single case or case seriesOne patient or a handful, described without a comparison. It can raise an idea; it cannot show that a treatment works.
  • Study without a control groupA group was treated and followed, but nobody was left untreated for comparison. Improvement may come from time, other care, or the placebo effect.
  • Controlled trialTreated patients were compared with a control: placebo, another treatment, or the untreated side of the face. Most exosome trials at this level are small and short.
  • Phase 3 resultsA large trial designed to prove a treatment works, the kind regulators usually require. No exosome product has published phase 3 results.
  • FDA approvedThe FDA has reviewed the evidence and approved the product for that use. No exosome product is approved for any use.

Marks: what the study found

A solid mark means a benefit over the comparison. Hollow or partly filled marks mean less.

  • Better than controlThe treated group did better than the comparison group on the main measures.
  • Mixed or short-lived resultSome benefit, but only on some measures, in a subgroup, or for a short time.
  • Similar to comparison treatmentAbout the same as another treatment, such as PRP, which may itself be unproven.
  • No benefit over controlThe treated group did no better than placebo or the comparison.
  • Improvement reported, no control groupPatients improved, but without a comparison group there is no way to tell whether the treatment caused it.
  • Safety onlyThe study looked for harms. It was not designed to show whether the treatment works.
  • Stopped for a safety eventThe study was halted after a serious problem in a participant.

More on how studies are graded

Showing 27 of 27
  1. Mixed or short-lived resultCOVID-19 lung disease and inhaled useStrength of design, level 3 of 5: Controlled trial

    Bone marrow stem cell vesicles (ExoFlo) for respiratory failure from COVID-19

    Lightner AL et al., CHEST, 2023. 102 people. Made from: bone marrow.

    No treatment-related adverse events. Lower 60-day mortality was seen in the higher-dose group and in a subgroup of patients aged 18 to 65.

  2. Better than controlPattern hair lossStrength of design, level 3 of 5: Controlled trial

    Adipose stem cell exosome injections compared with minoxidil for pattern hair loss

    Omar MS, Saeed MY, Journal of Sulaimani Medical College, 2025. 90 people. Made from: fat (adipose) stem cells.

    After 12 weeks, hair thickness and count increased more in the exosome group than with minoxidil. Final average hair diameter was 88.8 µm versus 74.2 µm.

  3. No benefit over controlCOVID-19 lung disease and inhaled useStrength of design, level 3 of 5: Controlled trial

    Stem cells with or without added vesicles for COVID-19 ARDS

    Zarrabi M et al., Stem Cell Research & Therapy, 2023. 43 analyzed (8 got cells plus vesicles). Made from: umbilical cord.

    Both treated groups had lower inflammatory markers than the control group, with no serious adverse events. A 2025 review of the trial reports no significant difference between cells alone and cells plus vesicles.

  4. Better than controlChronic kidney diseaseStrength of design, level 3 of 5: Controlled trial

    Umbilical cord stem cell vesicles for stage 3–4 chronic kidney disease

    Nassar W et al., Biomaterials Research, 2016. 40 people. Made from: umbilical cord.

    The authors reported better kidney function (eGFR) and lower inflammation markers in the treated group than with placebo.

  5. No benefit over controlKnee osteoarthritisStrength of design, level 3 of 5: Controlled trial

    Placental stem cell vesicles injected into the knee for osteoarthritis

    Bolandnazar NS et al., BMC Musculoskeletal Disorders, 2024. 31 people (62 knees). Made from: placenta.

    No difference from saline in pain, function, or MRI findings at 2 and 6 months. The injection was safe.

  6. Better than controlSkin agingStrength of design, level 3 of 5: Controlled trial

    Adipose stem cell exosome solution plus microneedling for facial aging

    Park GH et al., Journal of Cosmetic Dermatology, 2023. 28 people. Made from: fat (adipose) stem cells.

    Wrinkle measures improved 12–14% on the exosome side and about 7% on the saline side. Elasticity rose 11.3% on the exosome side and fell 3.3% on the saline side.

  7. Better than controlAcne scarsStrength of design, level 3 of 5: Controlled trial

    Adipose stem cell exosomes plus fractional CO₂ laser for acne scars

    Kwon HH et al., Acta Dermato-Venereologica, 2020. 25 people. Made from: fat (adipose) stem cells.

    Scar severity fell 32.5% on the exosome side and 19.9% on the control side. More exosome-treated sides improved by at least two grades (16 of 25 vs 12 of 25), and redness after laser was milder.

  8. Better than controlPattern hair lossStrength of design, level 3 of 5: Controlled trial

    Exosome formulation with seaweed and Thuja extracts injected for male pattern hair loss

    Amini F et al., Life, 2025. 24 randomized, 20 analyzed. Made from: not stated in the paper.

    At 16 weeks, hair count rose a median of 9.5 hairs in the treated group and 1.5 with placebo. Two treated men had mild scalp irritation that resolved on its own.

  9. Mixed or short-lived resultHyperpigmentationStrength of design, level 3 of 5: Controlled trial

    Adipose stem cell exosome gel for skin brightening

    Cho BS et al., Cosmetics, 2020. 21 women. Made from: fat (adipose) stem cells.

    Melanin levels dropped more on the exosome side than on the placebo side, with the largest difference at 4 weeks.

  10. Similar to comparison treatmentSkin agingStrength of design, level 3 of 5: Controlled trial

    Human and rose stem cell exosome blend compared with PRP after radiofrequency microneedling

    Investigator-blinded split-face trial, 2025 (PMC12104007). 15 people (from the investigators' conference abstract). Made from: human fat stem cells and rose stem cells.

    Skin biopsies looked similar on both sides, and investigators rated the exosome side slightly better, according to the investigators' conference abstract.

  11. No benefit over controlHealing after procedures and woundsStrength of design, level 3 of 5: Controlled trial

    Donor platelet vesicles injected into small skin wounds

    Johnson J et al., Journal of Extracellular Vesicles, 2023. 11 healthy volunteers. Made from: donor platelets.

    Safe and well tolerated. Wounds healed in about 23 days on average whether they got the vesicles or placebo.

  12. Better than controlHealing after procedures and woundsStrength of design, level 3 of 5: Controlled trial

    The patient's own serum vesicles for chronic venous leg ulcers

    Gibello L et al., Pharmacological Research, 2023. About 5 patients. Made from: patient's own blood serum.

    Treated ulcers formed more healthy granulation tissue than sham-treated ulcers: 3 of 5 treated ulcers reached 75–100% granulation, compared with none of the sham-treated ones.

  13. Safety onlyStrokeStrength of design, level 3 of 5: Controlled trial

    Placental stem cell exosomes injected into the brain after a large stroke

    Dehghani L et al., International Journal of Preventive Medicine, 2022. 5 treated patients. Made from: placenta.

    No bleeding, excess swelling, or other adverse effects at the injection site.

  14. Improvement reported, no control groupDry eye from graft-versus-host diseaseStrength of design, level 2 of 5: Study without a control group

    Umbilical cord stem cell exosome eye drops for dry eye from graft-versus-host disease

    Zhou T et al., Science Advances, 2022. 28 eyes. Made from: umbilical cord.

    In patients whose dry eye had not responded to other treatment, staining of the eye surface fell, tear film lasted longer, tear production rose, and symptom scores improved.

  15. Safety onlyCOVID-19 lung disease and inhaled useStrength of design, level 2 of 5: Study without a control group

    Inhaled adipose stem cell vesicles in healthy volunteers

    Shi M et al., Journal of Extracellular Vesicles, 2021. 24 healthy volunteers. Made from: fat (adipose) stem cells.

    All doses were well tolerated. Two people had a brief, mild slowing of heart rate that was not linked to dose.

  16. Improvement reported, no control groupCOVID-19 lung disease and inhaled useStrength of design, level 2 of 5: Study without a control group

    Bone marrow stem cell exosomes (ExoFlo) for severe COVID-19

    Sengupta V et al., Stem Cells and Development, 2020. 24 people. Made from: bone marrow.

    Oxygen levels, clinical status, and lab markers improved, survival was 83%, and no adverse events were seen within 72 hours.

  17. Improvement reported, no control groupKeloid scarsStrength of design, level 2 of 5: Study without a control group

    Placental stem cell exosomes injected after keloid removal

    Chernoff G, Journal of Surgery, 2022. 21 people. Made from: placenta.

    18 of 21 patients had no keloid regrowth over 2 years.

  18. Improvement reported, no control groupComplex anal fistulaStrength of design, level 2 of 5: Study without a control group

    Placental stem cell exosomes injected into complex anal fistulas (without Crohn's disease)

    Pak H et al., Journal of Gastroenterology and Hepatology, 2023. 11 people. Made from: placenta.

    10 of 11 patients showed improvement on physical examination, and the authors reported the treatment as safe.

  19. Improvement reported, no control groupAlzheimer's diseaseStrength of design, level 2 of 5: Study without a control group

    Adipose stem cell exosome nasal drops for mild to moderate Alzheimer's disease

    Phase I/II trial, General Psychiatry, 2023 (NCT04388982). 9 planned in the registry. Made from: fat (adipose) stem cells.

    No adverse events. In the medium-dose group, cognitive test scores improved compared with baseline at 12 weeks. Amyloid and tau deposits did not differ between dose groups.

  20. Improvement reported, no control groupCOVID-19 lung disease and inhaled useStrength of design, level 2 of 5: Study without a control group

    Inhaled adipose stem cell exosomes for severe COVID-19

    Zhu Y et al., Stem Cell Research & Therapy, 2022. 7 people. Made from: fat (adipose) stem cells.

    All patients tolerated treatment. Lymphocyte counts rose slightly, and lung lesions on CT regressed to varying degrees.

  21. Stopped for a safety eventLung disease in premature infantsStrength of design, level 2 of 5: Study without a control group

    IV stem cell vesicles (UNEX-42) for premature infants at high risk of chronic lung disease

    United Therapeutics, ClinicalTrials.gov NCT03857841. Stopped in the lowest-dose group. Made from: stem cells, tissue not specified here.

    The trial was stopped after one of the two infants in the lowest-dose group developed necrotizing enterocolitis, a serious bowel complication. A 2025 review describes the event as fatal.

  22. Improvement reported, no control groupSeveral skin conditionsStrength of design, level 1 of 5: Single case or case series

    Rose stem cell exosomes for skin conditions from healing to hyperpigmentation

    Case series and review, Journal of Cosmetic Dermatology, 2025. 8 people. Made from: plants (rose stem cells).

    The authors reported positive results across the eight cases, which covered several different skin conditions.

  23. Improvement reported, no control groupHealing after procedures and woundsStrength of design, level 1 of 5: Single case or case series

    Placental exosomes on the skin for healing after aesthetic procedures

    Peredo M, Shivananjappa S, Journal of Drugs in Dermatology, 2024. 3 people. Made from: placenta.

    The authors reported faster recovery, with less redness, swelling, and pain, in all three cases.

  24. Safety onlyKnee osteoarthritisStrength of design, level 1 of 5: Single case or case series

    First human knee injection of a clinical-grade umbilical cord vesicle product

    Figueroa-Valdés AI et al., Journal of Nanobiotechnology, 2025. 1 person. Made from: umbilical cord.

    No adverse effects over 12 months of follow-up.

  25. Improvement reported, no control groupAcne scarsStrength of design, level 1 of 5: Single case or case series

    Umbilical cord exosomes with subcision for severe acne scars

    Pastrana-López S, Journal of Stem Cell Research, 2024. 1 person. Made from: umbilical cord.

    The patient's acne scar score fell from 180 to 90 points.

  26. Improvement reported, no control groupPattern hair lossStrength of design, level 1 of 5: Single case or case series

    Exosomes with fractional picosecond laser for pattern hair loss with a white hair patch

    Lueangarun S et al., Journal of Cosmetic Dermatology, 2024. 1 person. Made from: not stated in the paper.

    Hair regrowth and return of hair color in a 38-year-old man, as summarized by a later trial report.

  27. Improvement reported, no control groupGraft-versus-host diseaseStrength of design, level 1 of 5: Single case or case series

    Stem cell exosomes for graft-versus-host disease that failed other treatment

    Kordelas L et al., Leukemia, 2014. 1 person. Made from: stem cells, tissue not specified here.

    Gut, skin, and mouth symptoms improved within about two weeks, and the steroid dose could be cut from 125 mg to 30 mg a day. The patient stayed stable for several months and died of pneumonia 7 months later.