Therapeutic Potential of Stem Cells in Hair Follicle Regeneration
Hair loss can be caused by many different factors such as hereditary, medical conditions, hormonal imbalances like thyroid dysfunction, autoimmune conditions, nutritional deficiencies, medicines, UV radiation, psychological factors like stress, and of course ageing. The damaging factors disturb the natural hair cycle and decrease stem cell activity and hair follicle regeneration capability.
Stem Cells in the Hair Follicle
Hair follicles have a niche for mature stem cells - hair follicular stem cells (HFSCs). These contain a rich supply of epithelial and melanocyte stem cells. HFSCs are also situated within the outer root sheath known as the “bulge”. HFSCs take part in the regeneration and the structure of hair follicles.
Stem cells of the “bulge” can remain in their niche where they self-regenerate, or they can also become progenitor cells which then form an internal hair follicle and the hair stem. The “bulge” has two compartments - the lower part which generates the internal hair follicle cell, and the upper part, which self-regenerates, but which does not directly participate in the regeneration of the hair follicle.
Another type of stem cells within the hair follicle is the dermal papilla cells which plays an important role in the regulation of hair growth and the formation of new hair follicles. Signals from these activate stem cells in the “bulge”.
Alopecia involves changes in two types of hair stem cells, both human hair follicle stem cells (HFSCs) and dermal papilla cells (DPCs). Although in some cases of scarring alopecia the progenitor cells are damaged, HFSCs are preserved in patchy and androgenic alopecia. This is why this type of alopecia can be reversible.
Stem cells in the bulge remain in the resting phase for most of their lives, but they can be activated depending on the hair cycle phase. It is reasonably understood that during the hair cycle, in the anagen phase, stem cells in the bulge are divided three times on average and stay within the niche. Stem cells in the bulge remain in the state of rest during the telogen phase, and between the telogen and anagen phases, they self-regenerate or migrate, creating a pool to form the hair matrix.
Stem Cell Use in Hair Follicle Regeneration
Stem cells can regenerate hair follicles in the skin. In the current state of knowledge, stem cells can be used to regenerate hair in several therapeutic means:
1) Reversing the mechanisms which contribute to hair loss and androgenic alopecia
2) Regeneration of complete hair follicles
3) Neogenesis of hair follicles from a stem cell
Use of Autologous Stem Cell in Hair Follicle Regeneration
Hair transplant has become a conventional treatment technique in androgenic alopecia. Although an autologous transplant is regarded as the gold standard, its usability is limited. Currently, methods are being developed which enhance the effectiveness of the use of autologous stem cells of the hair follicle.
Stem cells reside specifically in the hair follicle. They are called self-renewing stem cells (RSCs). When transplanted, RSCs integrate and participate in creating new hair follicles.
Gentile et al. demonstrated the application of an innovative Rigeneracons® bioreactor in order to provide autologous micrografts and their immediate use in clinical practice. They proved that cells isolated from the bulge region can improve the thickness of hair in patients affected by androgenic alopecia using a new method of isolating human mature stem cells obtained from a patient self-biopsy, without culturing. After the biopsy, a medical device Rigeneracons was used to obtain regenerative cells. After 23 weeks of therapy, after the last administration of stem cells, the average number of hairs and their thicknesses increased substancially compared to the start.
Furthermore, it has been evaluated that the regeneration potential was identified of these cells to induce the growth of a hair follicle injected to the skin.
Ibrahim et al. used autologous bone marrow stem cells to treat patchy alopecia and androgenic alopecia, and the therapeutic effects were compared to the group treated with autologous stem cells of hair follicles. Cells were administered in a single application, and a significant improvement was observed in all patient groups under treatment. Interestingly, the effect of stem cells was similar despite the fact that they had been obtained from two different sources. Bone marrow stem cells can stimulate hair growth as a consequence of the ability to differentiate into various cell types, the ability to secrete bioactive molecules which stimulate new blood vessels.
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