Baldness: Japanese scientists successfully create a new technique that stimulates hair growth; understand

Baldness: Japanese scientists successfully create a new technique that stimulates hair growth; understand

Using embryonic cells, researchers have developed functional hair follicles that can be implanted into individuals to promote hair growth

Researchers develop technique to reverse baldness.
Researchers develop technique to reverse baldness. — Photo: André Mello / Arte O Globo

Researchers at Yokohama National University in Japan have come a step closer to finding a cure for baldness. In a lab, scientists have managed to create hair follicles from mouse embryonic cells. When implanted into the animals, the follicles successfully generated hair and continued to function through multiple hair growth cycles. The study was published in the scientific journal Science Advances.

- Minoxidil Kirkland at Hairworld

The follicle is a bag-shaped structure that is located inside the skin, in the hypodermis. Inside it is where the root of the hair strand is located. Each follicle can generate about 3 to 5 strands. With the encouraging results, scientists believe that The method paves the way for future treatments for disorders that lead to hair loss. Another possibility is that growing in the laboratory could eliminate the need for animals to test chemicals.

"Our next step is to use human-derived cells and apply them to drug development and regenerative medicine," Junji Fukuda, a professor at Yokohama National University's faculty of biomedical engineering, said in a statement.

- Minoxidil Kirkland at Hairworld

To develop follicles in the laboratory that will be tested on humans, however, scientists explain that the process will be slightly different from the studies with mice. Instead of embryonic cells, for ethical and access to material reasons, they will use reverse engineering on cells. -trunk to reach the units present in the phase in which the individual is still a fetus in formation.

— We still have a lot of water to cover, but being able to understand this complex environment of follicle activation and inactivation, stimuli and inhibitions, that is, how this orchestra works, is already a big step in science, because we still don't have it 100% defined. In the last 5 to 10 years, we have been moving much faster, both in drug therapies, as well as cell and genetic therapies, so I have no doubt that soon we will have more and more new therapeutic options for the treatment of baldness — evaluates the dermatologist and coordinator of the hair department of the Brazilian Society of Dermatology regional of Rio de Janeiro (SBDRJ), Violeta Tortelly.

For Natasha Crepaldi, professor of dermatology residency at the Federal University of Mato Grosso (UFMT) and member of the Brazilian Society of Dermatology (SBD), if the technique proves effective in humans, it will in fact be a new and important alternative in the treatment of baldness.

— It will be essential to elucidate many stages of the functioning of the follicular unit that were previously little known and also for the early treatment of initial cases in which new follicles may impede progression and for advanced cases of baldness where there is no longer a viable donor area (from other parts of the hair) for the transplant. In addition, it will eliminate the need for medication before and after the transplant since hair follicles created (in the laboratory) will not have the pre-defined genetic response that causes baldness — explains the doctor.

- Minoxidil Kirkland at Hairworld

Tortelly emphasizes that the therapies available today seek to attack the cause of hair loss and stimulate existing hair, but they are unable to recover the hair that has been lost. Furthermore, the transplant option, which is the closest thing to new follicles, does not work in all cases.

— Currently, treatment is directed at the type of causative agent. The problem is that we cannot regrow hair that has already disappeared, so we stimulate the ones that are still there. Hence the importance of this new research for patients in whom the maximum stimulation has already been achieved and there are still areas of baldness that we cannot get around. Or that we can only achieve with hair transplantation, but in any case, even for transplantation, if the person is very bald the result may not be what we wanted — says the specialist.

There are different treatments available because baldness, called alopecia, can be of different types. The most common, called androgenetic, is related to male hormones and is therefore more prevalent among men. In these cases, it usually appears in the 20s and worsens over time. It is a hereditary condition, that is, passed down from generation to generation.

— Genetic inheritance is polygenic, that is, it does not come only from the mother or the father, it can come from any close relative. And as for the hormonal factor, what happens is that Dihydrotestosterone (DHT), a hormone that is synthesized by an enzyme from testosterone, binds to the receptors of the hair follicle and causes them to thin and reduce growth, which we call hair miniaturization. The hairs then become much less dense and thinner, going from the normal number of three to five hairs per follicle to just 1 or 2 hairs — says Crepaldi.

Another form that gained prominence as the diagnosis of former Big Brother Brasil contestant Lucas Penteado and actor Will Smith's wife, also actress Jada Smith, is alopecia areata. In this case, it is an autoimmune disease because the immune system itself attacks the hair follicles, preventing the production of new hairs.

Hair follicle generated in the laboratory. — Photo: Yokohama National University
Hair follicle generated in the laboratory. — Photo: Yokohama National University

The experiment

The researchers developed the new technique based on the natural formation of follicles during the embryonic phase. They explain that, at this time, an interaction occurs between the outermost layer of the skin, the epidermis, and the mesenchyme, a type of primary tissue that gives rise to the body's connective tissues, such as cartilage, bone, among others.

During this interaction, instructions are sent for the cells to organize themselves in the epidermis and form follicles. The mechanisms of this process, however, were not fully understood, which led to unsuccessful attempts to reproduce it in the laboratory.

The scenario changed with the arrival of organoids, considered one of the greatest scientific advances of recent decades. They are sets of cells created from embryonic cells or stem cells to reproduce genetic and physiological characteristics of a given organ or tissue in the body. With this, scientists can analyze processes and mechanisms that occur on a large scale in detail in the laboratory, developing "mini-organs" or "mini-tissues".

"Organoids were a promising tool to elucidate the mechanisms of hair follicle morphogenesis (creation) in vitro (in the laboratory),” said Tatsuto Kageyama, assistant professor at Yokohama National University’s faculty of biomedical engineering, in a statement.

They then manufactured hair follicle organoids from two types of embryonic cells, epithelial and mesenchymal, precisely to reproduce the interaction that occurs during fetal development. In addition, they used an extracellular matrix, a set of molecules that unites and defines the structure of cells during tissue formation.

The experiment was successful, with the organoids generating hair follicles and shafts (the visible part of the hair) with almost 100% efficiency. After 23 days of cultivation, the strands were about 3 mm long, an unprecedented feat that proved the organoids' ability to generate hair growth.

They then added a melanocyte-stimulating drug to the process. That's because melanocytes are the cells responsible for producing melanin, which gives hair its color. With the addition of the drug, hair pigmentation improved "significantly," the scientists reported. Finally, they transplanted the organoids into mice, which worked efficiently and through multiple hair growth cycles.

— This is important because follicles work in cycles, so there is a growth phase, a transition phase and a resting or hair loss phase — explains the UFMT professor.

Alternatives to baldness advance

The most common way to reverse hair loss from androgenetic alopecia available today is through the use of medication. Experts explain that drugs such as finasteride or dutasteride inhibit the enzyme that transforms testosterone into DHT, which consequently prevents the action that starts the process of miniaturization of the hair follicle and, subsequently, hair loss.

Another well-known medicine is minoxidil, a substance initially used as an antihypertensive, but which has been shown to act on hair growth. The mechanism by which it acts to achieve this goal is still uncertain, but experts point out that the substance improves blood flow to the scalp, which may be responsible for the benefits.

- Minoxidil Kirkland at Hairworld

Minoxidil is approved for topical use, as a lotion, but it does not work for everyone, nor can it reverse excessive hair loss - and is even less effective in cases of alopecia areata. Recently, studies have shown that an oral version of the substance, in low doses, provides a superior effect to its use applied to the skin. However, this formulation is not approved by regulatory agencies to treat alopecia.

In the specific case of alopecia areata, related to the immune system, another drug has shown promise: baricitinib. The drug was approved to treat the disease in the United States this year, and the same indication is already being analyzed by Brazil's National Health Surveillance Agency (Anvisa).

In two clinical studies, the drug resulted in complete or nearly complete hair growth after 36 weeks for 40 percent of participants. After a year, the rate increased to nearly 50 percent of patients. This effect occurs because the drug reduces the immune system's response, thus reducing attacks on the follicles.

In addition to drug treatments, an alternative for hair loss that grows is the most modern hair transplant, Follicular Unit Extraction (FUE). It can also be performed in the case of patients with alopecia areata, but it first requires stabilization of the condition and simultaneous treatment with medications that prevent the immune system from attacking the new follicles.

Developed in the United States, The technique involves removing functional follicles from a region called the donor area, which are then implanted in the area where hair growth is desired.

- Minoxidil Kirkland at Hairworld

To do this, hair is first shaved from an area with a high density of follicles, such as the back of the head, near the nape of the neck. During the surgery, each hair follicle is extracted one by one with an instrument called a micro punch. . Then, they are inserted into the area where the fall occurs.

After FUE, the follicles take around 90 days to develop and be born. This method is one of the most recommended for beard and hair transplants in cases of androgenetic alopecia because it is considered an effective, non-invasive technique that does not leave noticeable scars in the donor area.

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