https://stemcellsjournals.onlinelibrary.wiley.com/doi/full/10.1002/sctm.19-0301
Inspired by HF embryonic development, a 3D organ germ method was proposed for HF bioengineering, consisting in providing a native‐like 3D environment and maximizing EM cell interaction to mimic hair organogenesis.
70 Bioengineered follicle germs were shown to develop a correct structure when transplanted into the back skin of nude mice.
37,
70 Additionally, two recent studies have achieved growth of mouse hair in vivo after transplantation of in vitro formed structures, either consisting of mouse adult DP and epidermal cells,
72 or of mouse iPSCs,
73 encapsulated in hydrogel matrices. Different artificial 3D microenvironments composed of silk‐gelatin,
60 hyaluronic acid,
43 and collagen
65 were shown to improve hair germs for hair regenerative medicine. In a similar approach, human HF resembling vellus hair were recreated in vitro from a mixture of DP cells, keratinocytes and melanocytes in a collagen matrix, and named “microfollicles.”
76 Presently, researchers are joining efforts to develop more complex structures that can mimic the DP tridimensional morphology while providing a spatiotemporal delivery of molecular cues needed for human hair morphogenesis. Such a combined approach may favor cellular interactions in vitro, hopefully guiding the development and differentiation of both epithelial and mesenchymal counterparts to form a mature HF. To this end, recent work disclosed an interesting approach using a bioactive scaffold based on platelet‐rich plasma that synergistically combines 3D culture environment with natural release of endogenous growth factors.
71
Envisioning the large‐scale production of HF germs needed for a clinical setup, different innovative high‐throughput strategies have been conceived, using both mouse and human cells. 3D‐printing technology is currently being used in the hair research field to print 3D molds resembling HF microenvironment. Effective 3D‐printing of skin substitutes with human HFs has been recently reported.
36 Additionally, custom‐designed array plates were produced to allow scalable fabrication of inductive DP microtissues.
50,
65
Finally, an emerging trend in HF research is the in vitro reconstruction of artificial hair‐bearing skin. Relevantly, Zhang et al were able to generate HFs from cultured mouse DP cells in de novo engineered skin model.
67 Also, hair‐bearing human skin constructs were produced using innovative scaffolds that allow the development of properly oriented HFs.
36
Despite the above‐mentioned progress in HF bioengineering, the reconstitution of a fully organized and functional human HF resorting to cultured human cells is still missing. A regenerative medicine therapy for human hair loss will only be successfully achieved when HF are formed de novo following implementation of in vitro bioengineered structures into the patient's bald scalp. Importantly, although from a scientific perspective studies have achieved and reported HF regeneration from human cells,
36,
76 the caveats are whether (a) there is any mouse contribution in HF neogenesis from human bioengineered structures transplanted into mouse skin, and (b) human bioengineered structures will generate HF that besides growing/cycling also mimetic natural hair type and are responsive to physiological stimuli.
From a clinical perspective, an effective regenerative medicine would provide an autologous cell‐based bioengineered product able to cure hair loss without adverse side effects. Although promising, so far only hematopoietic stem cell‐based therapies have been implemented in the clinics. Moreover, significant limitations may further hamper an operational clinical solution for hair loss. First, bioengineered hair reconstruction will imply large‐scale production of cell‐based structures and the development of xeno‐free and well‐defined culture expansion media for clinical usage. Robust culture systems that allow stem cell expansion while maintaining their intrinsic properties are still missing. Second, even if generation of functional and cycling HF units is achieved, a huge gap still exists until the conception of a clinically relevant bioengineered product that responds to physiological stimuli (eg, neuronal stimuli) and aesthetic context (hair type, density, pigmentation, and orientation). For instance, larger bioengineered DPs could be required to generate thicker hair fibers, as DP size has been reported to impact on hair's diameter.
85 Third, the low efficiency of organ induction, together with glitches in HF eruption and/or growth direction, may hinder the establishment of the effective therapy. Finally, from an economic perspective, a cost‐effective cellular expansion and in vitro cell‐based bioengineering for hair loss will be challenging. The establishment of a patient‐customized therapy will necessarily make it highly expensive.
Considering all the above‐mentioned pitfalls that the hair‐cloning premise has faced over the last decades, it is not surprising why hair rejuvenation (by stimulating existing follicles) has become the goal post for treating hair loss.
CONCLUSION
Comprehensive knowledge of HF morphogenesis and cyclic regenerative regulation, together with optimized protocols for HF/stem cells isolation and culturing have boosted the creation of a wide range of bioengineering solutions aiming to cure hair loss. However, future efforts are still needed to bridge such knowledge into an effective translational tissue engineering solution. Importantly, the successful development of in vitro engineered human HFs will certainly suit major biological applications far beyond hair loss cure. The conception of biologically improved skin replacement therapies (whose usage has been limited by the absence of HF), or even their application as a research model for skin drug development or cosmetic products testing, turn the HF bioengineering a knowhow seeker by several medical and pharmaceutical industries.