Exosomes in hair re-growth

 Hair fall problem is common among both men and women. The medical term for hair loss is alopecia. It not only affects the scalp but also the entire body. The reasons for hair loss problem include age, auto immune condition (alopecia areata) with patches of baldness that usually grow back; medical condition such as thyroid disease, anemia, ringworm of the scalp, and anorexia; some medications such as cancer chemotherapy; heredity, hormonal changes after giving birth (telogen effluvium) or during menopause causing thinning of hair.

Treatment for hair loss:

If hair loss is due to medical condition it has to be addressed sooner. In other cases treatment is done with medications, surgery, grooming techniques, wigs and hair pieces. Finasteride (Propecia) is taken orally. It can help grow and thicken hair, but it is mainly used to retain hair that is still on the scalp so it works best for men who have more hair already. A topical medication Minoxidil (Rogaine) is applied directly to the scalp twice-daily. For men, it is used to treat male-pattern baldness. In women it is used to treat thinning hair. Genetic baldness is treated with Low-dose laser therapy also called as red light therapy, cold laser, soft laser, biostimulation, and photobiomodulation. Permanent hair loss can be treated with surgery. There are three common types of hair replacement surgery. A) Hair transplants where hair is taken from the back of the head and placed in front. B) Scalp reduction where bald areas are surgically removed and the hair-bearing areas of the scalp are stitched together. C) Scalp expansion where devices are inserted under the scalp to stretch the skin. This may be used before scalp reduction to help make the scalp relax, or on hair-bearing areas, which can reduce balding. These treatments will have minimal side effects. Exosome therapy is a new promising approach for the treatment of hair loss with good results without side effects.

What are Exosomes?

Exosomes are 30 to150 nm sized extracellular vesicles containing constituents like protein, DNA, and RNA of the cells that secrete them. They are taken up by distant cells, where they can affect cell function and behaviour. They acts as communicators and are seemed to be involved in the pathogenesis of various disorders, including cancer, neuro degeneration, and inflammatory diseases. When exosomes are injected into a hair follicle, they act as a catalyst for reawakening the process of nourishing follicles and facilitating growth. Here are some clinical evidences for exosome based hair loss treatment.

In vitro studies

Dermal papilla (DP) cells are mesenchymal derived cells located at the base of the hair follicle and play a critical  role in growth and cycling of hair follicles. Development and function of hair follicles are highly dependent on signaling between epithelial and DP cells through Wnt/β- catenin pathway. Many in vitro studies have quantified factors associated with Wnt/β- catenin pathway using DP cells as an experimental model as evidence reflective for hair growth. Studies have used a variety of cell types from which to isolate exosomes or conditioned media, including mesenchymal stem cells, adipose derived stem cells, dermal fibroblast cultures and DP cell cultures. Conditioned media from deer antler mesencymal stem cells increased Wnt/3a mRNA expression in DP cells resulting in enhanced proliferation of these cells compared to controls. On treating with extracellular vesicles from the deer antler mesenchymal stem cell conditioned media an even greater induction of Wnt/3a expression was observed, suggesting that the extracellular vesicles were the active compound in conditioned media that induced Wnt/3a expression. In other case extracellular vesicles isolated from media conditioned by mouse-bone marrow mesenchymal stem cells increased proliferation, migration as well as expression and release of growth factors in human DP cells. Studies using ex-vivo cultured human hair follicles found that DP cell derived exosomes increased hair shaft elongation and prolonged anagen phase. Exosomes isolated from activated human fibroblast cultures also enhance hair follicle growth ex-vivo. DP cell derived exosomes have also been shown to increase the expression of  β-catenin and Sonic Hedgehog in outer root sheath cells which are the factors implicated in promoting hair follicle development [1].

Animal studies

Intra dermal injections of  mesenchymal stem cell-derived exosomes in mice increased the rate of telogen to anagen transition and expression of Wnt3a and Wnt5a. It also prolonged anagen phase and delayed catagen phase. This study also showed that minoxidil treatment and exosome treatment had very similar results: complete hair growth in shaved mice by day 27, where as control mice only showed faint hair regrowth [1].

Human studies

Exosome therapy has yielded good results in humans. Hair density and thickness measurement is done at start and 12 weeks after exosome treatment in 20 patients with Androgenetic alopecia. The researchers said that thickness of the hair increased from 57.5 to 64.0µm and density of the hair increased from 105.5 to 122.7 hairs/cm². No adverse effects have been observed in the patients [1]. Clinical trials need to determine the best way to manufacture and apply exosome therapy and also if  different tissue sources of exosomes affect the therapeutic potential.

 Current scenario of exosomes in hair fall treatment:

 As far as now exosome therapy is found to be safe and effective in restoring hair follicles. The exosomes are safe because they are processed in the United States according to standards and regulations of the American Association of Tissue Banks and the United States Food & Drug Administration. The serum that contains higher concentrations of lab-derived growth factors is injected to the person.  This will stimulate the body to grow new hair. The procedure will take about 15 – 30 minutes, and the person will experience little to no discomfort. Exosomes are present for 6 to 8 months in our body after treatment. Anti-inflammatory medications during treatment are not recommended as they can interfere with their healing. Best of all, there is no danger of allergies or hypersensitivity with this treatment. Exosomes can be an affordable and effective way to treat hair fall problem.

References

1.     Aditya K.Gupta, Helen J. Renaud, Yael Halaas, Jeffrey A. Rapaport. “Exosomes: A New Effective Non-Surgical Therapy for Androgenetic Alopecia. SKINmed 2020;18:96-100