Narrator: Coming up on Mayo Clinic Q&A,
Dr. Saranya Wyles: Skin has this natural form to regenerate. It
turns over every month, so every 30 days we have new skin. And
it's a good thing because if we were to get a wound or a cut,
our body knows the signals to try to repair that.
Narrator: Even though our skin regenerates, it is subject to
damage as we age like age spots, discolored blotches and
wrinkles. While some of these effects of aging aren't
reversible, some can be treated with a regenerative medicine
approach, using therapeutics to restore, replace and repair
damaged skin.
Dr. Saranya Wyles: So, regenerative medicine is the
idea that we can reestablish form and function, and now we're
starting to talk about reprogramming and our ability to
be able to get ahead, turn back the clocks and maybe fight
disease earlier on.
Dr. Halena Gazelka: Welcome everyone to Mayo Clinic Q&A. I'm
Dr. Halena Gazelka. Regenerative Medicine is an emerging field
that looks to repair, replace or restore diseased cells, tissues
or organs. One specialty that's a natural fit for regenerative
medicine, is dermatology. Why? Because our skin is the largest
organ that regenerates in the body. Joining us to discuss
regenerating damaged skin is Dr. Saranya Wyles, a Mayo Clinic
dermatologist who specializes in regenerative medicine. Welcome
to the program, Saranya.
Dr. Saranya Wyles: Thank you, Dr. Gazelka. It's good to be
here with you.
Dr. Halena Gazelka: I am so excited to talk to you about
this because I didn't even know there were dermatologists who
specialized in regenerative medicine.
Dr. Saranya Wyles: Absolutely. It's a new field, and we're
bringing it to reality. So, essentially the skin, as you
said, is the largest organ that has that regenerative potential.
So, we're excited to see where we can take it.
Dr. Halena Gazelka: Can you explain what it means to say
that skin regenerates? And can you explain why skin is capable
of doing so?
Dr. Saranya Wyles: Absolutely. So, let's start with what is the
goal of regenerative medicine. So, regenerative medicine is the
idea that we can re-establish form and function. So, how we
are born, the natural skin that we have, that baby skin, and as
we age that sort of shifts and changes over time. So, how do we
bring these concepts whether using the regenerative medicine
toolkit which includes stem cells, and PRP, or platelet rich
plasma, and the new kid on the block is exosomes. So, how do we
utilize all of these different regenerative technologies to get
that skin to go back to regenerating or restoring that
form and function? You asked about how and why the skin can
regenerate. So, the skin has this natural form to regenerate,
it turns over every month. So, every 30 days, we have new skin.
And there are two different populations of stem cells that
are actually in our skin. So, one is that it's called
epidermal stem cells that's in the top layer of our skin. And
then the other one is the bulge stem cells, or it's in the hair
follicles. So, that can contribute to both hair
regeneration and skin regeneration. So, through these
populations, we turn over our skin naturally every month. And
it's a good thing because if we were to get a wound or a cut,
our body knows the signals to try to repair that.
Dr. Halena Gazelka: When you said, you had me at baby skin, I
have two little grandsons, and their skin is so soft. I'm
going to be your, I'm a happy patient of yours if you can make
my skin like that again.
Dr. Saranya Wyles: I know, don't they just have the best softer
skin.
Dr. Halena Gazelka: That's true. So, Saranya what are senescent
cells, and are they found in the skin, and where do they tend to
accumulate?
Dr. Saranya Wyles: Yeah, so before we talk about cellular
senescence or senescent cells, let's take a step back the
30,000 foot view, if you will. And that's to look at longevity.
So, longevity is the idea that we can live without the
consequences that we all witness in our lives from features of
aging. It seems inescapable, right? My grandmother, for
example, she spent the majority of her last decade fighting age
related dementia, so she struggled with poor quality of
health or health span. That's how well we live as opposed to
lifespan. That's how long we live. So, it's this bringing
this idea of longevity into skin aging is where we can talk about
senescent cells. So, senescent cells are the cells that
accumulate with age. And actually, it actually happens to
children as well. So, even babies, right after conception
and even preconception, we start to experience how aging can play
a role. And they are actually able to clear it. So, you know,
when we have senescent accumulation, it's a conserved
mechanism. So, if we were to look at different cell cycles,
so we have cells that are building blocks of our body,
they can proliferate or divide, they can die off, and then they
can go under senescence, where it's this sort of irreversible
cell state, we call them the zombie cells. So, these cells
they can start to accumulate, and when you're younger and you
accumulate them, it's actually, you know, it's a cancer evading
mechanism. So, it's evolutionarily conserved, a cell
gets a mutation, and your body can put it into senescence. So,
it stops right there earlier on in its tracks, and the immune
system can come and clear it away. But as we age, we start to
lose that ability to quickly clear senescence. So, that's
when we start to accumulate a lot of the secondary sequela
that can come with senescent cells. So, it's sort of thought
about as a biomarker for aging.
Dr. Halena Gazelka: So, what do senescent cells have to do with
things like scarring and wrinkles?
Dr. Saranya Wyles: Yeah, so senescent cells they have, they
can participate in pathology. So, especially in a lot of
disease states, like fibrosis, which is a part of how scarring
occurs, we see that senescent cells start to play a role. So,
they're not just, you know, taking on the stage becoming the
so called zombie cell. But they also are standing there with a
message. They start sending signals to every cell around
them. I kind of think of them as a rotten apple. So, you know,
have you heard like a rotten apple spoils the cart. So, you
know, senescent cells in our body actually hover around 1%.
So, there's not a lot of them. But it is enough to spoil the
cart. So, the cells that they are next to they will tell
fibroblasts, who are making normal healthy collagen, they'll
tell them to, you know, stop doing that. So, it's the signals
that they're secreting, even though they're a lower
population, that can really harm our natural process of collagen
regeneration and things like that.
Dr. Halena Gazelka: So, tell us a little bit about how
regenerative medicine can help turn back the clock on skin
conditions.
Dr. Saranya Wyles: Yeah, so if we think about nature and how,
you know, we actually get two resets in our lifetime. So, we
get a true reset of going back, turning back the clock at
conception. So when we're first born, and that embryo starts to
make different types of cells, we get a reset, and then around
50 cell state cycle, we get another reset. So, that's
actually when we start to make progeny, our grandchildren are
actually made when we were babies as well. So, those eggs
at that time get a reset, too. So beyond that, we start to age,
and I actually think aging is a privilege. You know, I don't
like the phrase anti-aging. So, it's a good thing that we get to
do this. But when we think about turning back the clocks,
recently about in 2006-2007, there was a Japanese scientist,
Shinya Yamanaka, and he discovered a Nobel Prize winning
technology. It's a very elegant experiment, actually. So, he had
these different combinations of genes that he started to put
together different permutations combinations. And he finally
unlocked the four genes that we would take to reset that clock
to go back in time again. So, if you were to take a skin
fibroblasts, say from your arm, and you added these genes, it
would actually turn them back and make it into a pluripotent
stem cell. So, it would go from your skin back into a stem cell.
So, that was very exciting technology. And now, we're start
starting to talk about reprogramming and our ability to
be able to get ahead, turn back the clocks and, and maybe fight
disease earlier on.
Dr. Halena Gazelka: Where can I get some of these genes?
Dr. Saranya Wyles: Yeah, so we're working on them in the
lab. You know, I mean, if we were to take your biopsy from
your skin right now and get some of the fibroblasts, we could
make a 20-year-old Dr. Gazelka.
Dr. Halena Gazelka: Oh, I'm stopping right on over. Saranya,
what is skin biohacking, and what tips do you have for that?
Dr. Saranya Wyles: Yeah, so the aging science field, discovered
that aging is not rigid. You know, just like we talked about
reprogramming, we kind of think about aging on this continuum,
and there's no going back, but it's actually flexible is pretty
malleable. And nature has bent and twisted these controls that
we can hack into or utilize to kind of get back into a
healthier state. So, for example, let's talk about
mammals. So, we can look at the shortest living mammal. It's
called the tiny shrew, and it lives less than a year. And then
we can look at the longest living mammal which is called
the bowhead whale, and it lives up to 200 years. So, that's a
200x fold difference in lifespan, right, within the same
mammals. So now, what is the difference and how come these
different species are able to hack into these different
lengths of life? And if we were to look at that they actually
found certain genes that we can knock down and actually extend
lifespan. So, nature has built in these control knobs within us
and now we're, as longevity leaders and kind of aging
scientists, we're looking at how we can hack into that and maybe
reduce the insults. You asked about skin biohacking. The
major, you know, UV radiation tends to be the number one kind
of insult to how we age from an extrinsic cost. So, really
making sure you're wearing sunscreen is the best thing that
you can do. Actually sun damage can cause these thymidine
dimers, or they're basically different types of DNA damage
that can go directly into how we're aging, and the aging
repair mechanisms get damaged. So, I would say making sure
that, you know, if you're not wearing sunscreen, at least
making sure you're protected, so you don't get a sunburn, because
the sunburn now switches you into the inflammation phase. And
so, that is an additional, you know, the chronic inflammation
aging that we're talking about. So, those are different ways
that we can really reduce our skin aging is to make sure we
prevent that UV radiation exposure, and stopping smoking
is another one.
Dr. Halena Gazelka: Saranya, what are the latest trends in
utilizing longevity science for our skin health?
Dr. Saranya Wyles: Yeah, so skin health and skin health span is
now really coming to the forefront. So, we're talking
about not only understanding chronological age, so I think
that idea of chronological age is going to fade into history.
We're going to now be talking about molecular aging. So, how
do we all age at different root causes of aging? So, for
instance, we talked about cellular senescence being a
biomarker for aging. There's different ways our mitochondria
get damaged, our telomeres get shortened. So, those are the
different ways, or the hallmarks of aging. So, the root causes.
So, instead of, you know, doing different treatments like Botox
and fillers and other anti-aging, if you will,
treatments, it's now going to be about biostimulation. So, how do
we target root causes and kind of reset our molecular aging
clock so, we kind of go back to why we're aging and slow that
down at an earlier standpoint. So, in terms of the latest
trends, you know, the regenerative medicine toolkit
offers some really exciting technology. The newest kid on
the block is exosomes. So, these are topical exosomes, they can
come from different sources, so they can come from mesenchymal
stem cells, or cells that are naturally in our body. They can
come from platelets, and we're actually doing a study here at
the Center ror Aesthetic Medicine and Surgery using
platelet derived exosomes, it's actually Mayo Clinic technology.
And we are actually very excited to share some of these results.
So, we just had our first publication, and so I think it's
these new technologies within regenerative medicine that are
going to look directly playing against that root cause of
aging.
Dr. Halena Gazelka: Fascinating. You mentioned a couple of things
that would help maintain healthy skin not smoking, wearing
sunscreen, are there other tips that you have for maintaining
healthy skin? And is there anything that can be done at
this point that is not just research to repair damaged skin?
Dr. Saranya Wyles: Yeah, so I think, you know, antioxidant.
So, how the skin age is through different oxidative stressors.
So, the way we can directly combat that is by antioxidant
properties. So, Vitamin C Serum is a commonly used serum that
actually targets superoxide dismutase, these different
enzymes that attack and accumulate with oxidative
stress. So, if we reduce that with vitamin C, which actually
plays two roles in the skin, so not only is it helpful for
antioxidant activity, it also is a cofactor during collagen
synthesis, so it helps build and make new collagen in our skin.
So, I always recommend to my patients to wear a vitamin C
serum in the mornings. And then at night, you can certainly do
something like a retinol or retinoid to see, that's again to
help boost your collagen turnover. So, those are
different ways that you can start to build on that healthy
skin. earlier on. You know, we've heard of the concept of
rejuvenation or regenerating or rejuvenating your skin. The new
idea is actually the idea of prejuvenation. So, it's starting
early, starting in your 20's. Starting in your 30's, even
before that if you can, and making sure you're kind of
investing in a good sunscreen that you wear every day,
investing in a good moisturizer so you keep that barrier intact,
in a good vitamin C serum. And then now these new products like
exosomes are coming through the forefront so we can see at what
point would it be beneficial to start utilizing that at an
earlier stage. So, it's an exciting time.
Dr. Halena Gazelka: One of the questions I always have Saranya,
you look at this myriad of products when you go into one of
the larger, you know, drugstores, makeup stores, etc.
And how do you really know whether you're getting a good
vitamin C product?
Dr. Saranya Wyles: That's a fantastic question. I think with
vitamin C, you really want to keep in mind that it can expire.
So, it's actually, it can oxidize. So, if you've looked at
the vitamin C bottles, they actually come in a dark
container. And that's because with exposure to air, they can
actually turn color and, and kind of turn into a non-usable
product. So, with vitamin C, their lifespan is really between
four to six weeks. So, you really want to make sure you get
a product that is within it and replace the product frequently.
Some of them depending on the container may say a little bit
longer, but my advice would always be able to get a smaller
quantity and replace it frequently. And then also, you
know, their prices vary significantly. So, really, you
know, targeting that 15-20%, ascorbic acid type of vitamin C,
that's really your goal range. So, once you're there, you know,
the more important thing would actually be to replace the
vitamin C frequently than to go for the higher end product.
Dr. Halena Gazelka: That's very good to know. This has been a
fascinating conversation, Saranya. We have covered zombie
cells, 200-year-old whales, molecular aging, and now vitamin
C. Thank you for being here.
Dr. Saranya Wyles: Thank you for having me. It was a pleasure to
be here.
Dr. Halena Gazelka: Saranya, do you have any last thoughts you
want to share with our listeners?
Dr. Saranya Wyles: Yeah, I think that this is a very exciting
time in science and medicine. You know, this is a convergence
of longevity and aging science and regenerative medicine.
There's a lot of hype out there, too at the same time. You know,
you'll be hearing about stem cells and a lot of promise that
comes around with it. So, I would just advise you to really
ask about the research that's being done and really know the
science and then decide on a product that would be best
fitting for you. So, at Mayo Clinic, you know, we have Mayo
Clinic technology, and we are making sure that we validate all
of these studies well before we deploy them out. So, you know,
looking for good science is a very important thing in a world
where we're faced especially in the cosmeceuticals and beauty
industry there's a lot out there. So, just make sure you
ask the right questions.
Dr. Halena Gazelka: Excellent advice. Thank you, Saranya.
Dr. Saranya Wyles: Thank you.
Dr. Halena Gazelka: Our thanks to Dr. Surendra Wyles, Mayo
Clinic dermatologist and regenerative medicine specialist
for being here today to talk to us about how regenerative
medicine can affect skincare and skin health. What a fascinating
topic. I hope that you learned something. I know that I did.
And we wish each of you a very wonderful day.
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