Mechanism and clinical efficacy of peripheral blood alive cell treatment on androgenic alopecia

To the Editor: Androgenic alopecia (AGA) is a common chronic hair loss disorder that usually begins in adolescence, with hair follicle miniaturization.[1] Clinical manifestations include reduced hair diameter and volume, potentially leading to baldness. AGA, characterized by progressive hair loss, can affect both sexes. Inflammation around the hair follicle, stress, emotional tension, and poor lifestyle and eating habits can further aggravate the symptoms of AGA.[2] Currently, minoxidil and finasteride (FNS) are the only drug therapies specifically approved for AGA by the FDA.[3] However, these two drugs have obvious side effects and poor patient compliance, so it is urgent to find a safe and effective clinical treatment method for AGA. The peripheral blood contains many bioactive components (ACT), including platelets, cytokines, blood proteins, and mononuclear cells (PBMCs). Previous studies showed that platelet-rich plasma (PRP) separated from peripheral blood regulated the hair follicle microenvironment, promoted angiogenesis, and accelerated hair growth by releasing numerous cytokines. PBMCs also contain a variety of stem cells and stem cell therapy has been shown to help restore the scalp hair growth cycle and promote hair follicle growth in patients with AGA. The current study aimed to explore the impact of ACT on human dermal papilla cells (hDPCs) and determine the efficacy and safety of ACT alone or in combination with oral FNS for the treatment of AGA. The study was approved by the Ethics Committee of Hainan Hospital of PLA General Hospital (No. HNS2024-001-01). This study conformed to the Declaration of Helsinki, and all participants provided written informed consent. Sixty male volunteers with AGA were enrolled in our study from October 2019 to September 2022. The patients were divided randomly into ACT and ACT + FNS groups. Randomization was carried out using a computer-based random number generation method, with no restrictions, interventions, or adjustments. Patients in the ACT group (n = 28) received ACT injections and patients in the ACT + FNS group (n = 32) received ACT injections in combination with oral FNS (Propecia; MSD, UK; 1 mg/day). AGA was diagnosed according to the Norwood Hamilton grades II–IV criteria. None of the participants had received any topical or systemic treatment for their hair loss during the last 6 months. Patients with a current or past history of immunosuppression, dermatological diseases affecting the scalp, autoimmune disorders, hematologic disorders, or platelet dysfunction syndrome, and patients receiving anticoagulation therapy were excluded from the study. Patients taking aspirin or other non-steroidal anti-inflammatory drugs discontinued their use 7 days before treatment. The diagnosis of AGA in all patients was based on a detailed medical history, including information on any drugs causing hair loss. Demographic and clinical characteristics of the two groups of volunteers are shown in Supplementary Table 1, https://links.lww.com/CM9/C74. There is no difference in the data of each group (P >0.05). We took photos and conducted trichoscopy tests on each volunteer before, after 3 months of treatment, and after 6 months of treatment [Supplementary Figure 1A, https://links.lww.com/CM9/C74]. Both groups of patients showed significant increases in hair counts after treatment. The number of hairs in the ACT group was significantly higher after treatment for 6 months compared with before treatment (P <0.05), but there was no significant difference after 3 months of treatment compared to before treatment (P >0.05). The hair quantity increased significantly at both 3 months and 6 months in the ACT + FNS group (P <0.05). However, there was no significant difference in the number of hairs between the two groups at 3 months or 6 months (P >0.05) [Supplementary Figure 1A,B, https://links.lww.com/CM9/C74]. The efficacy rates in the ACT and ACT + FNS groups after treatment for 6 months were 75.0% and 81.3%, respectively, with no significant difference between the two groups (P >0.05) [Supplementary Figure 1C, https://links.lww.com/CM9/C74]. There was no significant difference in any of the hair mirror indicators between the two groups before treatment (P >0.05). All indicators improved significantly (P <0.05) in both groups after treatment, including significant decreases in the proportions of terminal hair and single hair follicles, and significant increases in hair density and hair stem diameter. The treatments were therefore effective. After treatment, the proportions of single hair follicles were significantly lower and the terminal hair, hair density, and hair stem diameter were significantly higher in the ACT + FNS group compared with the ACT group (P <0.05) (Supplementary Figure 1A,D, https://links.lww.com/CM9/C74]. We also conducted preliminary research on the mechanism of action of ACT. Separate ACT and observe cell morphology [Supplementary Figure 2A, https://links.lww.com/CM9/C74] to determine the number of CD34+ positive cells [Supplementary Figure 2B, https://links.lww.com/CM9/C74], and determine the cellular components in ACT [Supplementary Table 2, https://links.lww.com/CM9/C74]. Separate and cultivate hDPCs, construct an AGA cell model induced by dihydrotestosterone, and use CCK8 and scratch experiments to determine that ACT can promote cell proliferation and migration [Supplementary Figure 2C,D, https://links.lww.com/CM9/C74]; through quantitative polymerase chain reaction and Western blotting experiments, it was found that ACT can activate Wnt/β-catenin signaling related genes [Supplementary Figure 3 and Supplementary Table 3, https://links.lww.com/CM9/C747]. In conclusion, ACT treatment can rapidly release numerous cytokines and promote hair follicle cell proliferation and migration, as well as increase blood circulation around hair follicles, provide nutrition, and reduce hair follicle cell apoptosis in patients with AGA. ACT injection alone or combined with FNS has significant therapeutic effects for the treatment of AGA, with good safety and promising clinical potential in patients with AGA. Funding This work was supported by grants from the Natural Science Foundation of Hainan Province (No. 820MS123), the Guangdong Enterprise Joint Fund (No. 2022A1515220137), and the Shenzhen Science and Technology Innovation Committee (No. JCYJ20220530141615035). Conflicts of interest None.