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Piccini I, Sousa M, Altendorf S, Jimenez F, Rossi A, Funk W, Bíró T, Paus R, Seibel J, Jakobs M, Yesilkaya T, Edelkamp J, Bertolini M. Intermediate Hair Follicles from Patients with Female Pattern Hair Loss Are Associated with Nutrient Insufficiency and a Quiescent Metabolic Phenotype. Nutrients 2022; 14:nu14163357. [PMID: 36014862 PMCID: PMC9416027 DOI: 10.3390/nu14163357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022] Open
Abstract
Female pattern hair loss (FPHL) is a non-scarring alopecia resulting from the progressive conversion of the terminal (t) scalp hair follicles (HFs) into intermediate/miniaturized (i/m) HFs. Although data supporting nutrient deficiency in FPHL HFs are lacking, therapeutic strategies are often associated with nutritional supplementation. Here, we show by metabolic analysis that selected nutrients important for hair growth such as essential amino acids and vitamins are indeed decreased in affected iHFs compared to tHFs in FPHL scalp skin, confirming nutrient insufficiency. iHFs also displayed a more quiescent metabolic phenotype, as indicated by altered metabolite abundance in freshly collected HFs and release/consumption during organ culture of products/substrates of TCA cycle, aerobic glycolysis, and glutaminolysis. Yet, as assessed by exogenous nutrient supplementation ex vivo, nutrient uptake mechanisms are not impaired in affected FPHL iHFs. Moreover, blood vessel density is not diminished in iHFs versus tHFs, despite differences in tHFs from different FPHL scalp locations or versus healthy scalp or changes in the expression of angiogenesis-associated growth factors. Thus, our data reveal that affected iHFs in FPHL display a relative nutrient insufficiency and dormant metabolism, but are still capable of absorbing nutrients, supporting the potential of nutritional supplementation as an adjunct therapy for FPHL.
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Affiliation(s)
- Ilaria Piccini
- Monasterium Laboratory Skin & Hair Research Solutions GmbH, 48149 Münster, Germany
| | - Marta Sousa
- Monasterium Laboratory Skin & Hair Research Solutions GmbH, 48149 Münster, Germany
| | - Sabrina Altendorf
- Monasterium Laboratory Skin & Hair Research Solutions GmbH, 48149 Münster, Germany
| | - Francisco Jimenez
- Mediteknia Hair Transplant Clinic and Hair Lab, Universidad Fernando Pessoa Canarias, Gran Canaria, Canary Islands, 35450 Guía, Spain
| | - Alfredo Rossi
- Department of Clinical Internal Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
| | | | - Tamás Bíró
- Monasterium Laboratory Skin & Hair Research Solutions GmbH, 48149 Münster, Germany
| | - Ralf Paus
- Monasterium Laboratory Skin & Hair Research Solutions GmbH, 48149 Münster, Germany
- Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | | | | | | - Janin Edelkamp
- Monasterium Laboratory Skin & Hair Research Solutions GmbH, 48149 Münster, Germany
| | - Marta Bertolini
- Monasterium Laboratory Skin & Hair Research Solutions GmbH, 48149 Münster, Germany
- Correspondence: ; Tel.: +49-(0)251-93263-080
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Integral Roles of Specific Proteoglycans in Hair Growth and Hair Loss: Mechanisms behind the Bioactivity of Proteoglycan Replacement Therapy with Nourkrin® with Marilex® in Pattern Hair Loss and Telogen Effluvium. Dermatol Res Pract 2020; 2020:8125081. [PMID: 32425997 PMCID: PMC7222612 DOI: 10.1155/2020/8125081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/01/2020] [Indexed: 11/30/2022] Open
Abstract
Follicular proteoglycans are key players with structural, functional, and regulatory roles in the growth and cycling behaviour of the hair follicles. The expression pattern of specific proteoglycans is strongly correlated with follicular phase transitions, which further affirms their functional involvement. Research shows that bioactive proteoglycans, e.g., versican and decorin, can actively trigger follicular phase shift by their anagen-inducing, anagen-maintaining, and immunoregulatory properties. This emerging insight has led to the recognition of “dysregulated proteoglycan metabolism” as a plausible causal or mediating pathology in hair growth disorders in both men and women. In support of this, declined expression of proteoglycans has been reported in cases of anagen shortening and follicular miniaturisation. To facilitate scientific communication, we propose designating this pathology “follicular hypoglycania (FHG),” which results from an impaired ability of follicular cells to replenish and maintain a minimum relative concentration of key proteoglycans during anagen. Lasting FHG may advance to structural decay, called proteoglycan follicular atrophy (PFA). This process is suggested to be an integral pathogenetic factor in pattern hair loss (PHL) and telogen effluvium (TE). To address FHG and PFA, a proteoglycan replacement therapy (PRT) program using oral administration of a marine-derived extract (Nourkrin® with Marilex®, produced by Pharma Medico Aps, Aarhus, Denmark) containing specific proteoglycans has been developed. In clinical studies, this treatment significantly reduced hair fall, promoted hair growth, and improved quality of life in patients with male- and female-pattern hair loss. Accordingly, PRT (using Nourkrin® with Marilex®) can be recommended as an add-on treatment or monotherapy in patients with PHL and TE.
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Rozner RN, Freites-Martinez A, Shapiro J, Geer EB, Goldfarb S, Lacouture ME. Safety of 5α-reductase inhibitors and spironolactone in breast cancer patients receiving endocrine therapies. Breast Cancer Res Treat 2019; 174:15-26. [PMID: 30467659 PMCID: PMC6773272 DOI: 10.1007/s10549-018-4996-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/24/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To provide dermatologists and oncologists with a foundation for practical understanding and uses of 5α-reductase inhibitors and spironolactone for breast cancer patients and survivors receiving endocrine therapies (ETs), including the effect of these treatments on sex hormone levels, any reported drug interactions, and any risk of malignancy. METHODS All published studies from January 1978 through April 2018 were considered, using databases such as PubMed, Google Scholar, and Science Direct. Forty-seven studies were included in this review. RESULTS There is no evidence of interactions between 5α-reductase inhibitors and spironolactone with ETs used in breast cancer. Sex hormone alteration with 5α-reductase inhibitor or spironolactone use is variable. Three randomized controlled trials, 1 case-control study, and 6 retrospective cohort studies, including 284 female patients, studied the effects of 5α-reductase inhibitors on serum estrogen levels. Levels were increased in 97 of 284 (34%) patients, decreased in 15 of 284 (5.3%) patients, and unchanged in 162 of 284 (57%) patients. Four retrospective cohort studies, 1 case study, and 1 double-blinded crossover study, including 95 female patients, assessed the effect of spironolactone on estrogen levels. Levels were increased in 25 of 95 (26%) patients, decreased in 6 of 95 (6.3%) patients, and unchanged in 64 of 95 (67%) patients. Ultimately, most patients did not have a significant alteration in the level of estrogen when using 5α-reductase inhibitors or spironolactone. No consistent evidence of increased risk of female breast cancer while on spironolactone was reported in 3 studies including 49,298 patients; the risk of breast cancer with the use of 5α-reductase inhibitors has not been studied. CONCLUSIONS Most patients did not show increased estrogen levels with spironolactone and there were no data suggesting increased risk of breast cancer. Based on hormonal and pharmacological activity, spironolactone may be considered for further research on alopecia and hirsutism in breast cancer patients.
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Affiliation(s)
- Raquel N Rozner
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, 16 East 60th Street, Suite 407, 4th Floor, New York, NY, 10022, USA
| | - Azael Freites-Martinez
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, 16 East 60th Street, Suite 407, 4th Floor, New York, NY, 10022, USA
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Eliza B Geer
- Multidisciplinary Pituitary and Skull Base Tumor Center, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Shari Goldfarb
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Mario E Lacouture
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, 16 East 60th Street, Suite 407, 4th Floor, New York, NY, 10022, USA.
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Freites-Martinez A, Shapiro J, van den Hurk C, Goldfarb S, Jimenez JJ, Rossi AM, Paus R, Lacouture ME. Hair disorders in cancer survivors. J Am Acad Dermatol 2018; 80:1199-1213. [PMID: 29660423 DOI: 10.1016/j.jaad.2018.03.056] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/06/2018] [Accepted: 03/11/2018] [Indexed: 12/19/2022]
Abstract
With increasing survival rates across all cancers, survivors represent a growing population that is frequently affected by persistent or permanent hair growth disorders as a result of systemic therapies, radiotherapy, surgical procedures, and therapeutic transplants. These hair disorders include persistent chemotherapy-induced alopecia, persistent radiotherapy-induced alopecia, endocrine therapy-induced alopecia and hirsutism, postsurgery alopecia and localized hypertrichosis, and persistent stem cell transplantation and targeted therapy-induced alopecia. The information contained in this continuing medical education series should facilitate a better understanding on hair disorders in cancer survivors so that adequate support and therapies may be provided.
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Affiliation(s)
- Azael Freites-Martinez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Corina van den Hurk
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Shari Goldfarb
- Breast Cancer Medicine Service, Department of Medicine, Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joaquin J Jimenez
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ralf Paus
- Dermatology Research Centre, University of Manchester, and the National Institute of Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom; National Institute of Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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5α-Reductase isozymes and aromatase mRNA levels in plucked hair from young women with female pattern hair loss. Arch Dermatol Res 2017; 310:77-83. [DOI: 10.1007/s00403-017-1798-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 02/04/2023]
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Heilmann-Heimbach S, Hochfeld LM, Paus R, Nöthen MM. Hunting the genes in male-pattern alopecia: how important are they, how close are we and what will they tell us? Exp Dermatol 2016; 25:251-7. [DOI: 10.1111/exd.12965] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Stefanie Heilmann-Heimbach
- Institute of Human Genetics; University of Bonn; Bonn Germany
- Department of Genomics; Life & Brain Center; University of Bonn; Bonn Germany
| | - Lara M. Hochfeld
- Institute of Human Genetics; University of Bonn; Bonn Germany
- Department of Genomics; Life & Brain Center; University of Bonn; Bonn Germany
| | - Ralf Paus
- Dermatology Research Centre; Institute of Inflammation and Repair; University of Manchester; Manchester UK
- Department of Dermatology; University of Münster; Münster Germany
| | - Markus M. Nöthen
- Institute of Human Genetics; University of Bonn; Bonn Germany
- Department of Genomics; Life & Brain Center; University of Bonn; Bonn Germany
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Harries M, Tosti A, Bergfeld W, Blume-Peytavi U, Shapiro J, Lutz G, Messenger A, Sinclair R, Paus R. Towards a consensus on how to diagnose and quantify female pattern hair loss - The ‘Female Pattern Hair Loss Severity Index (FPHL-SI)’. J Eur Acad Dermatol Venereol 2015; 30:667-76. [DOI: 10.1111/jdv.13455] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/16/2015] [Indexed: 12/19/2022]
Affiliation(s)
- M. Harries
- Salford Royal NHS Foundation Trust; The University of Manchester; Manchester UK
| | - A. Tosti
- University of Miami; Miami FL USA
| | | | | | - J. Shapiro
- University of British Columbia; Vancouver Germany
- New York University; New York NY USA
| | | | - A. Messenger
- Royal Hallamshire Hospital; University of Sheffield; Sheffield UK
| | - R. Sinclair
- University of Melbourne; Melbourne Australia
| | - R. Paus
- University of Manchester; Manchester UK
- University of Münster; Münster Germany
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Paus R, Langan EA, Vidali S, Ramot Y, Andersen B. Neuroendocrinology of the hair follicle: principles and clinical perspectives. Trends Mol Med 2014; 20:559-70. [DOI: 10.1016/j.molmed.2014.06.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 06/09/2014] [Accepted: 06/12/2014] [Indexed: 12/16/2022]
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Langan EA, Vidali S, Pigat N, Funk W, Lisztes E, Bíró T, Goffin V, Griffiths CEM, Paus R. Tumour necrosis factor alpha, interferon gamma and substance P are novel modulators of extrapituitary prolactin expression in human skin. PLoS One 2013; 8:e60819. [PMID: 23626671 PMCID: PMC3634033 DOI: 10.1371/journal.pone.0060819] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/03/2013] [Indexed: 12/31/2022] Open
Abstract
Human scalp skin and hair follicles (HFs) are extra-pituitary sources of prolactin (PRL). However, the intracutaneous regulation of PRL remains poorly understood. Therefore we investigated whether well-recognized regulators of pituitary PRL expression, which also impact on human skin physiology and pathology, regulate expression of PRL and its receptor (PRLR) in situ. This was studied in serum-free organ cultures of microdissected human scalp HFs and skin, i.e. excluding pituitary, neural and vascular inputs. Prolactin expression was confirmed at the gene and protein level in human truncal skin, where its expression significantly increased (p = 0.049) during organ culture. There was, however, no evidence of PRL secretion into the culture medium as measured by ELISA. PRL immunoreactivity (IR) in female human epidermis was decreased by substance P (p = 0.009), while neither the classical pituitary PRL inhibitor, dopamine, nor corticotropin-releasing hormone significantly modulated PRL IR in HFs or skin respectively. Interferon (IFN) γ increased PRL IR in the epithelium of human HFs (p = 0.044) while tumour necrosis factor (TNF) α decreased both PRL and PRLR IR. This study identifies substance P, TNFα and IFNγ as novel modulators of PRL and PRLR expression in human skin, and suggests that intracutaneous PRL expression is not under dopaminergic control. Given the importance of PRL in human hair growth regulation and its possible role in the pathogenesis of several common skin diseases, targeting intracutaneous PRL production via these newly identified regulatory pathways may point towards novel therapeutic options for inflammatory dermatoses.
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Affiliation(s)
- Ewan A. Langan
- Dermatology Research Centre, Manchester Academic Health Science Centre, and Institute of Inflammation and Repair, University of Manchester, Manchester, United Kingdom
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Silvia Vidali
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Natascha Pigat
- Inserm U845/Centre de Recherche Croissance et Signalisation, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Erika Lisztes
- DE-MTA “Lendület” Cellular Physiology Research Group, Department of Physiology, University of Debrecen, Debrecen, Hungary
| | - Tamás Bíró
- DE-MTA “Lendület” Cellular Physiology Research Group, Department of Physiology, University of Debrecen, Debrecen, Hungary
| | - Vincent Goffin
- Inserm U845/Centre de Recherche Croissance et Signalisation, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Christopher E. M. Griffiths
- Dermatology Research Centre, Manchester Academic Health Science Centre, and Institute of Inflammation and Repair, University of Manchester, Manchester, United Kingdom
| | - Ralf Paus
- Dermatology Research Centre, Manchester Academic Health Science Centre, and Institute of Inflammation and Repair, University of Manchester, Manchester, United Kingdom
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- * E-mail:
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Abstract
Female pattern hair loss (FPHL) was originally described as synonymous with androgenetic alopecia. However, the role of androgens in FPHL has not been proven, and the etiology is not yet defined. Several patterns of hair loss in women have been described, in addition to descriptions of scarring alopecias mimicking FPHL. In this paper, we discuss FPHL as an entity other than androgenetic alopecia and suggest that de-emphasizing the physicians reliance on pattern in the diagnosis of hair loss in women, and instead utilizing other tools including dermoscopy and histopathology, would benefit clinician's efforts in treating alopecias.
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Inui S, Itami S. Androgen actions on the human hair follicle: perspectives. Exp Dermatol 2012; 22:168-71. [PMID: 23016593 DOI: 10.1111/exd.12024] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2012] [Indexed: 01/15/2023]
Abstract
Androgens stimulate beard growth but suppress hair growth in androgenetic alopecia (AGA). This condition is known as 'androgen paradox'. Human pilosebaceous units possess enough enzymes to form the active androgens testosterone and dihydrotestosterone. In hair follicles, 5α-reductase type 1 and 2, androgen receptors (AR) and AR coactivators can regulate androgen sensitivity of dermal papillae (DP). To regulate hair growth, androgens stimulate production of IGF-1 as positive mediators from beard DP cells and of TGF-β1, TGF-β2, dickkopf1 and IL-6 as negative mediators from balding DP cells. In addition, androgens enhance inducible nitric oxide synthase from occipital DP cells and stem cell factor for positive regulation of hair growth in beard and negative regulation of balding DP cells. Moreover, AGA involves crosstalk between androgen and Wnt/β-catenin signalling. Finally, recent data on susceptibility genes have provided us with the impetus to investigate the molecular pathogenesis of AGA.
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Affiliation(s)
- Shigeki Inui
- Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Osaka, Japan.
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Cousen P, Messenger A. Female pattern hair loss: beyond an androgenic aetiology? Reply from authors. Br J Dermatol 2010. [DOI: 10.1111/j.1365-2133.2010.09956.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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