enya FASHION QUEEN

EDITOR Chih-Chiang Chen、Jong-Ling Fuh｜TRANSLATOR Chih-Chiang Chen、Jong-Ling Fuh｜PROOFREADER Annie Chien｜PHOTO Chih-Chiang Chen、Jong-Ling Fuh

外泌體（exosome）曾經只是細胞分泌的小囊泡，一度被認為是「細胞的垃圾袋」。但科學界在近二十年對其生物功能的理解，已徹底改變這種看法——我們現在知道，外泌體不僅是細胞之間的重要「信差」，更蘊藏治療、修復、診斷甚至美學應用的巨大潛力。

本文將從三個層面探討：外泌體在神經退化性疾病治療上的新契機、其在再生醫學領域的挑戰與突破，以及全球產業界對外泌體的高度投入與趨勢觀察。

本期由台北榮民總醫院皮膚部主任-陳志強醫師與台北榮民總醫院神經醫學中心副主任-傅中玲醫師聯名刊登。

The New Blue Ocean of Exosome Medicine: From Neurological Disorders to the Rise of the Global Aesthetics Industry

Exosomes were once thought to be nothing more than tiny vesicles—cellular “garbage bags.” However, two decades of scientific breakthroughs have dramatically shifted this view. Today, we know that exosomes are not only essential messengers between cells but also hold immense potential in therapy, tissue repair, diagnostics, and even aesthetic applications. This article explores three key areas: new opportunities for treating neurodegenerative diseases, the challenges and advances in regenerative medicine, and global industry trends surrounding exosomes.

神經退化性疾病，如帕金森氏症與阿茲海默症，是全球老化社會面臨的重要議題。目前的藥物主要用於延緩病程與緩解症狀，尚未能逆轉或修復神經損傷。外泌體在此領域提供了新的研究方向。

✦ 外泌體能穿越血腦障壁

外泌體可以穿越血腦障壁（BBB），這是治療中樞神經系統疾病的一大難題。由於間質幹細胞或神經幹細胞的外泌體具有天然生物相容性、低免疫原性和穿過血腦屏障的特性，它們被視為治療神經退化性疾病的理想載體。此外，外泌體還能提供神經保護，調節基因表達，改善突觸功能和促進神經發生。

✦ 應用於帕金森氏症與阿茲海默症

帕金森氏症的主要病理特徵是中腦黑質多巴胺神經元的進行性變性死亡，導致多巴胺分泌不足。此外，α-突觸核蛋白 ( α-synuclein) 在神經細胞內異常積累形成路易小體 (Lewy bodies) 也是其顯著特徵。一些研究正在探索外泌體是否能清除或抑制 α-synuclein 的錯誤折疊和聚集，從而減緩疾病進程。外泌體可以作為載體，將特定的神經滋養因子、基因或藥物遞送到受損的多巴胺能神經元，以促進其存活和功能恢復。阿茲海默症的病理特徵包括細胞外 β-澱粉樣蛋白(Abeta)斑塊的積累和細胞內 tau 蛋白過度磷酸化形成的神經纖維纏結。一些研究表明，外泌體能夠直接結合並清除細胞外的 Abeta或攜帶能降解 Abeta的酶，從而減少Abeta的積累。外泌體還具有攜帶多種神經保護因子的能力，包括抗炎分子和抗氧化劑，這些因子可以減輕神經炎症和氧化壓力。此功能在帕金森氏症與阿茲海默症均有幫助。

臨床試驗仍處於早期階段，外泌體在神經退化性疾病的診斷和治療中具有潛力，但面臨挑戰。高效分離、純化外泌體技術尚需突破，確保其體內穩定性及精準定位病變區域是關鍵問題。外泌體作為治療產品，需要嚴格的安全評估和標準化生產流程。此外，外泌體的具體作用機制仍需深入研究，以優化治療策略。

Neurodegenerative diseases, such as Parkinson’s disease and Alzheimer’s disease, are significant issues faced by aging societies worldwide. Current medications are primarily used to slow the progression and alleviate symptoms, but they have not yet been able to reverse or repair nerve damage. Exosomes offer a new research direction in this field.

✦ Exosomes Can Cross the Blood–Brain Barrier

Exosomes can cross the blood-brain barrier (BBB), which is a major challenge in treating central nervous system diseases. Due to the natural biocompatibility, low immunogenicity, and ability to cross the BBB of exosomes derived from mesenchymal stem cells or neural stem cells, they are considered ideal carriers for treating neurodegenerative diseases. Additionally, exosomes can provide neuroprotection, regulate gene expression, improve synaptic function, and promote neurogenesis.

✦ Applications in Parkinson’s and Alzheimer’s Disease

The main pathological feature of Parkinson’s disease is the progressive degeneration and death of dopaminergic neurons in the substantia nigra of the midbrain, leading to insufficient dopamine secretion. Additionally, the abnormal accumulation of α-synuclein within neurons forming Lewy bodies is also a significant characteristic. Some studies are exploring whether exosomes can clear or inhibit the misfolding and aggregation of α-synuclein, thereby slowing the progression of the disease. Exosomes can serve as carriers to deliver specific neurotrophic factors, genes, or drugs to damaged dopaminergic neurons to promote their survival and functional recovery. The pathological features of Alzheimer’s disease include the accumulation of extracellular β-amyloid (Abeta) plaques and the formation of neurofibrillary tangles due to excessive phosphorylation of intracellular tau protein. Some studies suggest that exosomes can directly bind to and clear extracellular Abeta or carry enzymes that degrade Abeta, thereby reducing Abeta accumulation. Exosomes also have the ability to carry various neuroprotective factors, including anti-inflammatory molecules and antioxidants, which can alleviate neuroinflammation and oxidative stress. This function is beneficial for both Parkinson’s disease and Alzheimer’s disease.

Clinical trials are still in the early stages, and while exosomes have potential in the diagnosis and treatment of neurodegenerative diseases, they face challenges. Efficient isolation and purification techniques for exosomes need to be developed, ensuring their stability in vivo and precise targeting of affected areas are key issues. As therapeutic products, exosomes require rigorous safety assessments and standardized production processes. Additionally, the specific mechanisms of exosomes need to be further studied to optimize treatment strategies.

幹細胞療法在再生醫學中曾被譽為「萬靈丹」，然而面對實務應用時卻面臨多重障礙，包括來源倫理、移植風險、免疫排斥與腫瘤化可能性。因此，外泌體作為「無細胞替代品」的角色逐漸受到重視。

✦ 外泌體是幹細胞治療的核心效應者？

事實上，越來越多證據指出，幹細胞植入後的療效並非來自細胞本身持續存活與分化，而是來自其分泌的外泌體。這些囊泡包含的miRNA、蛋白質與脂質等成分，能調控受損組織的發炎反應、細胞增殖與血管新生，是修復過程的真正主角。

這也意味著，外泌體療法有可能提供與幹細胞類似甚至更佳的效果，卻能避開許多細胞治療的風險與法規瓶頸。

✦ 實際應用領域廣泛

目前，外泌體在心肌梗塞後修復、糖尿病足潰瘍、脊髓損傷、骨關節再生等領域皆有動物實驗與初步臨床證據支持其療效。例如，脂肪幹細胞衍生的外泌體被證實可促進皮膚與血管再生，提升傷口癒合速度，未來有望應用於慢性傷口處理與術後復原。

不過，要真正取代幹細胞治療，外泌體在純化、定量、標準化製程與儲存穩定性等方面仍需突破。

Stem cell therapies were once hailed as the “panacea” of regenerative medicine. However, real-world applications have been hindered by ethical concerns, risks of transplantation, immune rejection, and tumorigenicity. As a result, exosomes are gaining traction as a cell-free alternative.

✦ Are Exosomes the Main Effectors in Stem Cell Therapy?

An increasing body of evidence suggests that the therapeutic benefits of stem cell transplantation are primarily due to the exosomes they secrete, rather than the direct engraftment or differentiation of the cells. These vesicles contain miRNAs, proteins, and lipids that regulate inflammation, promote cell proliferation, and stimulate angiogenesis—making them the true drivers of tissue repair.

This suggests that exosome therapy may offer outcomes comparable to or even better than stem cell therapy, while avoiding many associated risks and regulatory hurdles.

✦ Broad Range of Applications

Exosomes are showing therapeutic potential in animal studies and early clinical research for myocardial infarction recovery, diabetic foot ulcers, spinal cord injuries, and joint regeneration. For example, exosomes derived from adipose-derived stem cells have been shown to promote skin and vascular regeneration and accelerate wound healing. These findings point to potential use in chronic wound care and post-surgical recovery.

Nevertheless, to fully replace stem cell therapies, improvements in exosome purification, quantification, standardization, and storage stability are still needed.

隨著研究成果陸續出爐，外泌體也從實驗室走進產業界，特別是在美容醫學與生技產業中掀起一波熱潮。

✦ 美容醫學的新寵兒

外泌體保養品與療程成為近年醫美市場的新話題，尤其在亞洲地區如韓國、日本與台灣，已有多家品牌推出強調「外泌體抗老」、「修復力導入」、「雷射術後修復」的產品。外泌體的天然成分、安全性與低過敏性，使其受到注重「自然恢復」與「非侵入性療法」消費者的青睞。

目前主流應用包括：

1. 術後加速癒合（如微針、雷射後的修復霜）
2. 抗皺與緊實精華液
3. 頭皮養護與毛囊活化療程

不過由於外泌體的來源與純化技術差異極大，產品品質仍有待監管與標準化。

✦ 生技與醫療產業的投資焦點

根據市場預測報告，全球外泌體相關市場將於2030年前達到百億美元規模。各大藥廠與生技新創正積極投入外泌體的藥物遞送、診斷平台、疫苗開發與個人化醫療設計。例如，美國與歐洲已有外泌體平台公司啟動臨床試驗，目標將其作為阿茲海默症、癌症或自體免疫疾病的療法載體。

台灣近年也有學研單位與生技公司合作，開發高純度外泌體純化技術、量產流程與智慧醫療結合平台，顯示外泌體正逐步成為產學合作的熱點。

As research advances, exosomes are moving out of the lab and into industry, sparking a wave of excitement—particularly in aesthetic medicine and biotechnology.

✦ The New Darling of Aesthetic Medicine

Exosome-based skincare products and treatments have become hot topics in the medical aesthetics market. In Asia—especially Korea, Japan, and Taiwan—many brands have launched products that tout “exosome-based anti-aging,” “repair infusion,” and “post-laser recovery” benefits. Thanks to their natural composition, safety profile, and low allergenicity, exosomes are favored by consumers seeking “natural restoration” and non-invasive therapies.

Current mainstream applications include:

1. Post-treatment wound healing (e.g., creams for microneedling or laser recovery)
2. Anti-wrinkle and skin-firming serums
3. Scalp care and hair follicle activation therapies

However, due to variations in exosome sourcing and purification techniques, product quality still requires better regulation and standardization.

✦ A Key Investment Target in Biotech and Healthcare

Market forecasts predict that the global exosome market will reach multi-billion-dollar levels by 2030. Major pharmaceutical firms and biotech startups are investing heavily in exosome-based drug delivery, diagnostics, vaccine development, and personalized medicine. In the US and Europe, several exosome platform companies have initiated clinical trials, aiming to use exosomes as delivery vehicles for therapies targeting Alzheimer’s, cancer, or autoimmune diseases.

In Taiwan, collaborations between academia and biotech firms have emerged to develop high-purity purification technologies, scalable production processes, and smart medical platforms—positioning exosomes as a hot topic in academic–industrial partnerships.

從中樞神經系統的精密修復，到再生醫學的安全替代方案，再延伸至美容與診斷的產業應用，外泌體的潛力正被各界挖掘與放大。雖然目前仍處於發展初期，仍需面對技術與法規的種種挑戰，但不可否認，外泌體已是下一波生醫革命的重要推手。

在這個以精準醫療、無細胞治療與個人化保養為核心的時代，外泌體或許正是那個銜接科學與生活、醫療與美學的關鍵橋梁。

From precision CNS repair to a safer alternative in regenerative medicine—and now expanding into beauty and diagnostics—exosomes are being explored and elevated across disciplines. While still in the early stages of development and facing technical and regulatory hurdles, there’s no denying that exosomes are a driving force behind the next wave of biomedical innovation.

In an era defined by precision medicine, cell-free therapies, and personalized care, exosomes may just be the vital bridge linking science and daily life, medicine and aesthetics.

本期由陳志強醫師與傅中玲醫師聯名刊登

陳志強簡歷

學歷：
-國立陽明大學醫學士
-國立陽明大學臨床醫學研究所博士

現職：
-台北榮民總醫院皮膚部主任
-國立陽明交通大學皮膚學科主任
-社團法人台灣皮膚科醫學會理事
-社團法人台灣皮膚科技教育學會常務理事
-社團法人台灣檢驗及品保學會理事
-社團法人台灣乾癬暨皮膚免疫學會理事

傅中玲簡歷

現任：
-台北榮民總醫院神經醫學中心副主任
-國立陽明交通大學醫學院教授
-美國神經學學會院士
-亞洲抗失智學會理事
-中華醫學會雜誌副主編
-台灣臨床失智症學會理事
-衛生福利部身心障礙鑑定專家小組委員
-醫策會專科醫師訓練計畫分組委員

學經歷：
-陽明醫學院醫學系畢業
-曾任美國加州大學洛杉磯分校(UCLA) 阿茲海默氏症中心臨床研究員
-台灣臨床失智症學會理事長
-台灣神經學學會甄審委員會主任委員
-臺北榮民總醫院人體試驗委員會副執行秘書和委員，臨床和學術專長為失智症、行為神經學和頭痛。

得獎紀錄：
-中華民國行政院退除役官兵輔導委員會99年優良醫師
-中華民國行政院退除役官兵輔導委員會104年優良醫師
-中華民國行政院退除役官兵輔導委員會106年臨床教學績優醫師獎
-中華民國行政院退除役官兵輔導委員會110年臨床教學績優醫師獎