Advancing Regenerative Cellular Therapies in Non-Scarring Alopecia

Abstract

Alopecia or baldness is a common diagnosis in clinical practice. Alopecia can be scarring or non-scarring, diffuse or patchy. The most prevalent type of alopecia is non-scarring alopecia, with the majority of cases being androgenetic alopecia (AGA) or alopecia areata (AA). AGA is traditionally treated with minoxidil and finasteride, while AA is treated with immune modulators; however, both treatments have significant downsides. These drawbacks compel us to explore regenerative therapies that are relatively devoid of adverse effects. A thorough literature review was conducted to explore the existing proven and experimental regenerative treatment modalities in non-scarring alopecia. Multiple treatment options compelled us to classify them into growth factor-rich and stem cell-rich. The growth factor-rich group included platelet-rich plasma, stem cell-conditioned medium, exosomes and placental extract whereas adult stem cells (adipose-derived stem cell-nano fat and stromal vascular fraction; bone marrow stem cell and hair follicle stem cells) and perinatal stem cells (umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs), Wharton jelly-derived MSCs (WJ-MSCs), amniotic fluid-derived MSCs (AF-MSCs), and placental MSCs) were grouped into the stem cell-rich group. Because of its regenerative and proliferative capabilities, MSC lies at the heart of regenerative cellular treatment for hair restoration. A literature review revealed that both adult and perinatal MSCs are successful as a mesotherapy for hair regrowth. However, there is a lack of standardization in terms of preparation, dose, and route of administration. To better understand the source and mode of action of regenerative cellular therapies in hair restoration, we have proposed the “À La Mode Classification”. In addition, available evidence-based cellular treatments for hair regrowth have been thoroughly described.

Human Stem Cell Use in Androgenetic Alopecia: A Systematic Review

“…HFSCs on autologous micrografts and cultured HFSCs. Perinatal stem cells included umbilical cord blood derivatives, MSCs from Wharton’s jelly, MSCs from amniotic fluid, and MSCs from the placenta [ 10 ]. Cell transplantation is one of the strategies to achieve the functional regeneration of hair follicles.…”

“…The adipose tissue is a storage area for regenerative molecules. Indeed, a variety of regenerative products can be generated from adipose tissue, including nano fat, vascular stem cell fraction (SVF), MSCs, adipose-derived stem cell conditioning medium (ADSC-CM), and extracellular veins (EV) [ 10 ]. The stromal vascular fraction (SVF) refers to all the cellular elements of the adipose tissue and is formed from heterogeneous cell population components of this tissue: adipocytes, blood cells, endothelial cells, extracellular matrix, and the most essential elements which are adipose-derived stromal/stem cells (ASC) [ 17 , 18 ].…”

“…Bone marrow is the main source of MSC. Many animal models showed the progression from the telogen phase to the anagen phase after the intradermal injection of mesenchymal cells from bone marrow (BM-MSC) and induced genes involved in hair regeneration [ 10 , 21 ]. Yoo et al [ 22 ] studied the influence of MSCs from the umbilical cord and bone marrow on human hair proliferation in vitro.…”

Standardization and validation of a conventional high yield platelet-rich plasma preparation protocol

“…They are rich in growth factors necessary for tissue regeneration and healing. There is a growing list of indications of its use across disciplines ranging from orthopedics [ 2 ], rheumatology [ 3 ] to plastic surgery [ 4 , 5 ], dentistry [ 6 ], and oral maxilla facial surgery [ 7 ]. Although various meta-analyses have proven their effectiveness across various indications [ [8] , [9] , [10] ], we did also find some studies reporting their ineffectiveness despite the robust study design [ 11 ].…”

Standardization and Validation of a High Yield Conventional Platelet-rich Plasma Preparation Protocol

“…1 They are rich in growth factors necessary for tissue regeneration and healing. There is a growing list of indications of its use across disciplines ranging from orthopedics, 2 rheumatology 3 to plastic surgery, 4 dentistry, 5 and oral maxilla facial surgery. 6 Although various meta-analyses have proven their effectiveness across various indications, [7][8][9] we did also nd some studies reporting their ineffectiveness despite the robust study design.…”