A Scoping Review of Exosome Delivery Applications in Hair Loss.

Sarah Schaffer, Lily Tehrani, Braeden Koechle, Prathmica Chandramohan, Brookie Hilburn et al.

Review Cureus 2025 7 trích dẫn

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Study Design

Loại nghiên cứu: scoping_review
Cỡ mẫu: 16

Can thiệp: A Scoping Review of Exosome Delivery Applications in Hair Loss. variable; exosomes predominantly from mesenchymal stem cells (MSCs)
Đối chứng: Placebo
Xu hướng hiệu quả: Positive
Nguy cơ sai lệch: High

Abstract

The objective of this scoping review was to understand the extent and type of evidence found in the current literature on the delivery mechanisms of exosome therapeutics and how these methods can work synergistically with existing treatments for alopecia. Alopecia is primarily characterized as non-scarring or scarring (cicatricial). In cicatricial alopecia, the hair follicles are irreversibly destroyed, causing permanent hair loss. In non-cicatricial alopecia, the hair follicles are undamaged, allowing for possible hair regeneration. Non-scarring alopecia includes androgenetic alopecia, telogen effluvium, and alopecia areata. Current treatments for non-scarring alopecia include oral minoxidil and spironolactone. Exosome therapeutics are a possible alternative treatment for non-scarring alopecia because of their regenerative properties in hair follicle stimulation, customizable size selection, and the potential to activate and down-regulate specific pathways that enhance hair growth. This review evaluates types and sources of exosome delivery as regenerative treatments for alopecia. A search of literature published in English from 2018 to 2023 was performed using the electronic databases EMBASE, Ovid MEDLINE, and Web of Science. Data from selected studies included specific details about the participants, concept, context, study methods, and key findings relevant to the review questions. Upon completion of the database search that yielded 1,087 citations, after removing 284 duplicates, 803 articles remained for assessment of eligibility. Finally, 16 studies were retained for inclusion. These studies explored one or more exosome delivery techniques, such as intradermal needle injection, microneedle patches, topical application, and topical application with a secondary assistive device. The therapeutic focus of these studies ranged from hair follicle regeneration and wound healing to spinal cord injury repair and collagen regeneration for cosmetic purposes. Most of the studies (14 out of 16) used exosomes derived from mesenchymal stem cells (MSCs), while others isolated exosomes from human adipose stem cells, macrophage cell lines, and dermal fibroblast cells. Of the 16 studies, all but two administered exosomes via microneedle patches. The findings suggest that intradermal microneedle patches are a promising method for delivering exosomes into tissues, particularly for the treatment of non-cicatricial alopecia. Exosome therapy shows strong potential for promoting hair follicle regeneration, supported by its proven efficacy in wound healing, spinal cord injury repair, and cosmetic applications. Among the various delivery methods explored, microneedle patches loaded with exosomes from MSCs emerged as the most effective for targeted delivery into tissues. These findings support exosome-based therapies for non-cicatricial alopecia.

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Figures

Figure 1

PRISMA flow diagram or literature search strategy for the scoping review of exosome delivery applications in hair loss treatment.

flowchart

Figure 2

Summary of preclinical and clinical evidence on exosome-based therapies for hair regeneration, categorized by source, delivery method, and outcomes.

diagram

Tables

Table 1

Author	Study Design	Sample	Primary Outcomes
Bui et al. (2022) [35]	Quasi-experimental	Twenty six-week-old mice, divided into five groups, with each group containing four mice	Significant increase in dermal thickness, collagen production, and fibroblast proliferation following EV@MN treatment compared to other delivery methods.
Zhao et al. (2022) [42]	Randomized Control Trial	Six 6–8-week-old mice, divided into two groups, with each group containing three mice	Incorporating LPNs into MN patches provides a targeted and minimally invasive delivery method, which could be relevant for exploring exosome delivery to specific skin layers.
Zhang et al. (2023) [41]	Randomized Control Trial	Twelve eight-week-old male rats, divided into four groups, with each group containing three rats	A novel approach of utilizing light-controlled MN for drug delivery to effectively eliminate ROS, promote angiogenesis, and resist bacterial infection in DFU.
Zhang et al. (2023) [34]	Randomized Control Trial	Twelve diabetic rats, divided into four groups, with each group containing three rats	MSC-exosome-loaded indwelling microneedles significantly promote wound healing in diabetic rats, with faster and more effective wound closure, improved tissue regeneration, enhanced collagen deposition, and reduced inflammation compared to other treatments.
Zeng et al. (2023) [38]	Randomized Control Trial	Four eight-week-old female rats, divided into four groups	MEs@PMN application increased macrophage polarization towards the M2 phenotype in vitro, suppressed inflammation, and promoted vascular regeneration to accelerate diabetic wound healing.
You et al. (2023) [39]	Randomized Control Trial	Twenty-four female mice, divided into six groups, with each group containing four mice	EVs containing mRNA for collagen production can effectively promote collagen formation and reduce wrinkle formation in photoaged mouse skin.
Yerneni et al. (2022) [37]	Quasi-experimental	Twenty 12-week-old male and female rats, divided into five groups, with each group containing four rats	dMNA-delivered curcumin-loaded extracellular vesicles (CA-EVs) effectively enhance drug delivery, inhibit NF-κβ activation, and reduce inflammation in both in vitro and in vivo models of skin inflammation.
Yang et al. (2019) [33]	Quasi-experimental	Twenty-one seven-week-old mice, divided into seven groups, with each group containing three mice	Keratin-based MN patch significantly enhanced hair regrowth by activating hair follicle stem cells, outperforming subcutaneous exosome injections and topical treatments.
Song et al. (2023) [32]	Randomized Control Trial	Five six-week-old male rats and mice, divided into five groups	BOR-modified LIPS fused with exosomes from MSCs and loaded with ZIC improved the ability of crossing the BBB and provide analgesic effects on various pain distributions
Shi et al. (2022) [36]	Randomized Control Trial	Twenty-four seven-week-old male mice, divided into four groups, with each group containing six mice	A drug-free MN patch containing CL and exosomes from ADSCs facilitated hair growth through regulation of the hair follicle cycle; significantly promoted hair regeneration within 7 days compared to topical minoxidil administration; anti-bacterial properties of CL decreased infection risk.
Park et al. (2023) [28]	Randomized Control Trial	Twenty-eight human subjects with facial skin aging underwent a split-face experiment, with one side receiving the treatment and the other serving as the control	MN combined with HACS significantly improved facial skin aging, wrinkles, elasticity, hydration, and pigmentation compared to microneedling with saline, with more pronounced collagen and elastic fiber density in histological evaluations.
Lin et al. (2022) [40]	Quasi-experimental	Forty-five mice, divided into nine groups, with each group containing five mice	DMN co-loaded with rapamycin and EGCG effectively penetrated the skin and showed targeted drug delivery, superior hair regeneration, and hair follicle activation and growth through enhanced β-catenin and p-AKT expression.
Han et al. (2022) [31]	Quasi-experimental	Fifteen mice, divided into five groups, with each containing three mice	Exosomes derived from MSCs cultured in three-dimensional environments (3D-Exo) exhibit superior therapeutic efficiency for SCI repair compared to conventional 2D-derived exosomes. A 3D-exohydrogel MN array patch enabled controlled in situ exosome release, reducing inflammation and glial scarring.
Gan et al. (2022) [30]	Randomized Control Trial	Thirty-two rats, divided into four groups, with each group containing eight rats	A multifunctional MN patch, composed of MSC-exos and AgNPs, significantly accelerated diabetic wound healing by relieving inflammation, promoting angiogenesis, and suppressing bacterial infection.
Fang et al. (2023) [29]	Randomized Control Trial	Fifty-seven rats, divided unevenly into six experimental groups: Control (n = 9), MN (n = 8), Gel-EV (n = 9), Gel-MSC (n = 10), MN-EV (n = 10), and MN-MSC (n = 11)	MN-MSC patch, which facilitated sustained delivery of MSC-derived EVs, effectively reduced inflammation, promoted tissue repair, and protected axons in a spinal cord injury model. Treatment led to improved functional recovery, as seen by better hindlimb motor function, higher BBB scores, and increased axonal survival and regrowth compared to other treatments.
Chernoff et al. (2023) [27]	Case Series	The study enrolled 40 patients (35 females, 5 males, ages 34–72), divided into eight groups, with each group containing five people	Exosome dermal infusion, enhanced with NO, ultrasound, and LED therapy, promoted skin regeneration. Skin priming with an exosome mixture prior to CaHA injections accelerates and enhances results.

Table 2

Boolean Operator	Search Term
	(minoxidil':ab,ti,kw OR 'finasteride':ab,ti,kw OR 'duasteride':ab,ti,kw OR 'spironolactone':ab,ti,kw OR 'cyproterone acetate':ab,ti,kw OR 'corticosteroids':ab,ti,kw OR 'janus kinase inhibitor':ab,ti,kw)
OR	(('exosome':ab,ti,kw OR 'exosome therapy':ab,ti,kw OR 'extracellular vesicle':ab,ti,kw)
OR	('alopecia':ab,ti,kw OR 'non-cicatricial alopecia':ab,ti,kw OR 'hair loss':ab,ti,kw OR 'hairloss':ab,ti,kw OR 'hair regeneration':ab,ti,kw OR 'non scarring alopecia':ab,ti,kw OR 'hair regrowth':ab,ti,kw OR 'hair growth':ab,ti,kw)))
AND	(('microneedle':ab,ti,kw OR 'micro needling':ab,ti,kw OR 'low level laser therapy':ab,ti,kw OR 'laser assisted thus drug deliver':ab,ti,kw OR 'platelet rich plasma':ab,ti,kw OR 'platelet rich fibrin':ab,ti,kw OR 'autologous conditioned plasma':ab,ti,kw)
AND	(('exosome':ab,ti,kw OR 'exosome therapy':ab,ti,kw OR 'extracellular vesicle':ab,ti,kw) OR ('alopecia':ab,ti,kw OR 'non-cicatricial alopecia':ab,ti,kw OR 'hair loss':ab,ti,kw OR 'hairloss':ab,ti,kw OR 'hair regeneration':ab,ti,kw OR 'non scarring alopecia':ab,ti,kw OR 'hair regrowth':ab,ti,kw OR 'hair growth':ab,ti,kw).