Regenerative medicine and carboxytherapy: a promising combination for androgenetic alopecia

Main Article Content

Antonio Luca Amore
Emanuele Bartoletti
Alessandro Gennai

Keywords

Aesthetic Medicine, regenerative medicine, androgenetic alopecia, carboxytherapy

Abstract

Background: Androgenetic alopecia, a disease that affects 70% of men and 40% of women, is characterized by the gradual miniaturization of the hair follicle, resulting from the alteration of the dynamics of the hair cycle. Aim: One of the most recent and promising advanced medical therapies is regenerative medicine. The important action of Adipose Derived Stem Cells (ADSCs) on the hair follicle is that of inducing anagen by stimulating the stem cells of the hair follicle. The Fibroblastic growth factor expressed by ADSCs also plays an important role in regulating the bulge and in the basal layer of the epidermis, inducing follicular neogenesis. In association with regenerative therapy, carboxytherapy was used with its neoangiogenic potential, exerts its synergistic action. Methods: This study aims to evaluate the effectiveness of the technique used for the therapy of androgenetic alopecia. The protocol involved the association of carboxytherapy and regenerative therapy through the grafting of vascular stromal fraction and mesenchymal stem cells of adipose origin. Through trichoscopic images and the use of innovative software, the data relating to the clinical variations of the pathology examined were extrapolated and subsequently statistically analysed. Results: 10 patients were enrolled (6 men and 4 women). To evaluate the clinical evolution of the pathology in question, both the clinical scales (Norwood in men and Ludwig in women) and the data extrapolated from the trichoscopic images relating to the ratio between the number of terminal hairs present for each vellus hair (PT/PV) were considered. The variation proved to be statistically significant both by analyzing the average of all areas (P = 0.0018) and by analyzing the areas with the best and worst ratios (P = 0.0032 and P = 0.0106 respectively). Conclusions: In consideration of the significance of the data obtained, this study demonstrates once again how the association of regenerative therapy and carboxytherapy is an optimal combination in the treatment of androgenetic alopecia.

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References

1. Girman CJ, Hartmaier S, Roberts J, Bergfeld W, Waldstreicher J. Patient perceived importance of negative effects of androgenetic alopecia in women. J Womens Health Gend Based Med. 1999; 8(8):1091-5.
2. Blanpain C, Lowry WE, Geoghegan A, Polak L, Fuchs E. Self-renewal, multipotency, and the existence of two cell populations within an epithelial stem cell niche. Cell. 2004; 118(5):635-48.
3. Botchkarev VA, Kishimoto J. Molecular control of epithelial– mesenchymal interactions during hair follicle cycling. J Investig Dermatol Symp Proc. 2003; 8(1):46-55.
4. Kishimoto J, Burgeson RE, Morgan BA. Wnt signaling maintains the hair inducing activity of the dermal papilla. Genes Dev. 2000; 14(10):1181-5.
5. Paus R. Control of the hair cycle and hair diseases as cycling disorders. Curr Opin Dermatol 1996; 3:248-58.
6. Kwack MH, Kim MK, Kim JC, Sung YK. Dickkopf 1 promotes regression of hair follicles. J Invest Dermatol 2012:132:1554-60.
7. Mahé YF, Michelet JF, Billoni N, et al. Androgenetic alopecia and microinflammation. Int J Dermatol. 2000; 39(8):576-84.
8. Philpott MP, Sanders DA, Bowen J, Kealey T. Effects of interleukins, colony-stimulating factor and tumour necrosis factor on human hair follicle growth in vitro: A possible role for interleukin-1 and tumour necrosis factor alpha in alopecia areata. Br J Dermatol. 1996; 135(6):942-8.
9. Amore AL, Bartoletti E, Gennai A. The role of regenerative medicine in androgenetic alopecia treatment: an uncontrolled clinical trial. Aesthetic Medicine. 2022; 8(1).
10. Strong AL, Neumeister MW, Levi B. Stem Cells and Tissue Engineering: Regeneration of the Skin and Its Contents. Clin Plast Surg. 2017; 44:635–650.
11. Campos-Muñoz A. Advanced therapies in current Medicine. Actual Med. 2017; 102(802):133.
12. Wang L, Ji H, Zhou J, et al. Therapeutic potential of umbilical cord mesenchymal stromal cells transplantation for cerebral palsy: a case report. Case Rep Transplant. 2013; 2013:146347.
13. Maxson S, Lopez EA, Yoo D, Danilkovitch-Miagkova A, Leroux MA. Concise review: role of mesenchymal stem cells in wound repair. Stem Cells Transl Med. 2012; 1(2):142–149.
14. Kim S, Lee SK, Kim H, Kim TM. Exosomes Secreted from Induced Pluripotent Stem Cell-Derived Mesenchymal Stem Cells Accelerate Skin Cell Proliferation. Int J Mol Sci. 2018; 19(10):3119.
15. Yates CC, Rodrigues M, Nuschke A, et al. Multipotent stromal cells/mesenchymal stem cells and fibroblasts combine to minimize skin hypertrophic scarring. Stem Cell Res Ther 2017; 8(1):193.
16. Almalki SG, Agrawal DK. Key transcription factors in the differentiation of mesenchymal stem cells. Differentiation. 2016; 92(1-2):41–51.
17. Park JS, Yang HN, Woo DG, Jeon SY, Park KH. The promotion of chondrogenesis, osteogenesis, and adipogenesis of human mesenchymal stem cells by multiple growth factors incorporated into nanosphere-coated microspheres. Biomaterials. 2011; 32(1):28–38.
18. Miyagawa I, Nakayamada S, Kondo M, Tanaka Y. Regulatory Mechanism of The Induction of Regulatory T Cells through Growth Factors Released by Human Mesenchymal Stem Cells. Crit Rev Immunol. 2018; 38(6):471–478.
19. Puissant B, Barreau C, Bourin P, et al. Immunomodulatory effect of human adipose tissue-derived adult stem cells: comparison with bone marrow mesenchymal stem cells. B J Haematol. 2005; 129(1):118–129.
20. Bourin P, Bunnell BA, Casteilla L, et al. Stromal cells from the adipose tissue- derived stromal vascular fraction and culture expanded adipose tissue- derived stromal/stem cells: a joint statement of the International Federation for Adipose Therapeutics and Science (IFATS) and the International Society for Cellular Therapy (ISCT). Cytotherapy. 2013; 15(6):641–8.
21. Gimble JM, Bunnell BA, Frazier T, et al. Adipose-derived stromal/stem cells. Organogenesis. 2013; 9(1):3–10.
22. Nguyen A, Guo J, Banyard DA, et al. Stromal vascular fraction: a regenerative reality? Part 1: current concepts and review of the literature. J Plast Reconstr Aesthetic Surg. 2016; 69(2):170–9.
23. Debnath T, Chelluri LK. Standardization and quality assessment for clinical grade mesenchymal stem cells from human adipose tissue. Hematol Transfus Cell Ther. 2019; 41(1):7–16.
24. Silva JD, Lopes-Pacheco M, Paz AHR, et al. Mesenchymal Stem Cells from Bone Marrow, Adipose Tissue, and Lung Tissue Differentially Mitigate Lung and Distal Organ Damage in Experimental Acute Respiratory Distress Syndrome. Crit Care Med. 2018; 46(2):e132–e140.
25. Zare H, Jamshidi S, Dehghan MM, Saheli M, Piryaei A. Bone marrow or adipose tissue mesenchymal stem cells: Comparison of the therapeutic potentials in mice model of acute liver failure. J Cell Biochem. 2018; 119(7):5834–5842.
26. Tesauro P, Trivisonno A, Gennai A, Marliani A, Clauser L. Hair Transplantation in Cicatricial Alopecia: The Role of Autologous Fat Transfer. Int J Regen Med. 2020; 3(2):1-11.
27. Doghaim NN, El-Tatawi RA, Neinaa YME, Abd El-Samd MM. Study of the efficacy of carboxytherapy in alopecia. J Cosmet Dermatol. 2018; 17(6):1275-1285.
28. Guarrera M, Cardo P, Arrigo P, Rebora A. Reliability of hamilton-norwood classification. Int J Trichology. 2009; 1(2):120-2.
29. Gennai A, Zia S, Roda B, et al. SEFFI (Superficial Enhanced Fluid Fat Injection) for Aesthetic and Clinical Regenerative Treatments. Global J Dermatol Venereol. 2020; 8:32-40.
30. Gennai A, Bernardini FP. Superficial enhanced fluid fat injection (SEFFI and MicroSEFFI) in facial rejuvenation. CellR4. 2017; 5(1):e223.
31. Gennai A, Zambelli A, Repaci E, et al. (2016) Skin Rejuvenation and Volume Enhancement with the Micro Superficial Enhanced Fluid Fat Injection (M-SEFFI) for Skin Aging of Periocular and Perioral Regions. Aesthet Surg J. 2017; 37(1):14-23.
32. Bernardini FP, Gennai A. Fluid Fat Injection for Volume Restoration and Skin Regeneration of the Periocular Aesthetic Unit. JAMA Plastic Facial Surg. 2015; 18(1):68-70.
33. Bernardini FP, Gennai A, Izzo L, et al. Superficial Enhanced Fluid Fat Injection (SEFFI) to Correct Volume Defects and Skin Aging of the Face and Periocular Region. Aesthet Surg J. 2015; 35(5):504-515.
34. Clauser L, Lucchi A, Trussardi TI, Gardin C, Zavan B. Autologous fat transfer for facial augmentation and regeneration: Role of mesenchymal stem cells. Atlas Oral Maxillofac Surg Clin North Am.2018; 26(1):25-32.
35. Trivisonno A, Di Rocco G, Cannistra C, et al. Harvest of superficial layers of fat with a microcannula and isolation of adipose tissue-derived stromal and vascular cells. Aesthet Surg J. 2014; 34(4):601-613.
36. Gennai A, Tesauro P, Colli M, Zia S, Roda B, Zattoni A. Infranatant Portion of Microfragmented Adipose Tissue: A Promising Source of SVF for the Management of Androgenetic Alopecia. Int J Regenr Med. 2021.