WCM 2024 Conference Highlights

Dr Glynis Ablon kicked off our last full day in Miami with an in-depth discussion of 2 popular treatments in hair aesthetics: platelet-rich plasma (PRP) and exosomes. Both PRP and exosomes can act as adjunct treatments to other procedures including with each other. Differentiating between the 2, PRP is an autologous blood component that harnesses the secretory prowess of activated platelets, specifically the alpha-granules they release, which contain growth factors and various other cytokines involved in angiogenesis, remodeling, coagulation, and inflammation. After extraction, PRP remains stable for about 4 hours. Notably, the FDA does not classify PRP as a human cellular/tissue product, and all systems require a 510(k) clearance to be sold. Exosomes, on the other hand, are endogenous nanoparticles released by stem cells to create phenotypic change via growth factors to enhance healing and collagen synthesis, miRNA to regulate gene expression, and cytokine to invigorate cells. Since they include mRNA and miRNA, they have effects long after that of cytokines and growth factors alone. Exosomes can come purified, which are frozen and contain intact active exosomes, as well as lyophilized in a powder that requires reconstitution, or suspended in a cream. We await studies to demonstrate the integrity of lyophilized exosomes, but they are appealing to consumers in a variety of skin care products. Exosomes also are present in small numbers in PRP and in some plants, though plant-derived exosomes will not bind to human-derived cell receptors and thus efficacy may be limited. Other concerns regarding exosomes include the limited quality control measures, stem-cell sourcing, and the scalability of the extensive and expensive purification process. There also isn’t a set standard for treatment frequency. Unfortunately, as of now, there are few clinical trials involving exosomes related to dermatology, but that may change in 2024.

Gary Goldenberg, MD, focused on regenerative techniques in this up-to-date lecture on nonsurgical treatment of hair loss. He started with platelet-rich plasma (PRP), which harnesses the power of platelet products including growth factors, chemokines, and cytokines to promote cell differentiation and proliferation. Specifically, platelet-derived, vascular endothelial, fibroblast, epidermal, insulin-like, and connective tissue growth factors are responsible for these benefits, which explain this treatment’s usefulness in the treatment of androgenetic alopecia. PRP promotes anagen-associated angiogenesis and neovascularization, dermal papilla cell proliferation, and anti-apoptotic effects. The anagen phase of the hair cycle is extended as dermal papilla cells are protected from premature breakdown. Both dosing at 3 monthly sessions with subsequent injections 3 months later or 2 sessions every 3 months lead to statistically significant increases in hair count, though another trial sponsored by a PRP system manufacturer did show increased hair density with monthly injections compared to quarterly. Further, PRP can be effectively used as an adjunct treatment to many other treatments including microneedling and minoxidil. He moved on to discuss exosomes which are vesicles for intercellular communication, and beyond growth factors, enzymes, and chemokines, also contain mRNA and miRNA. In and of themselves, exosomes could be good or bad, but those used in dermatology are often derived from mesenchymal stem cells, conveying messages to develop into various connective tissues supporting regenerative functions. In hair loss, in addition to the benefits from growth factors and chemokines given by PRP, exosomes also promote hair matrix cell proliferation to revitalize degenerative follicles. Other examples of multipotent stem cells sources are umbilical cord blood and adipose tissue. However, the number of multipotent stem cells present in adipose tissue depends on host factors such as age and general health. Harnessing these cells for hair loss could be in the form of inducing the generation of CK19 positive cells and hairlike structures from mesenchymal stem cells. There are a few small trials that have used adipose-derived stem cells for alopecia, but larger randomized controlled trials are needed.