The Market for Alopecia Treatments and the Promise of Advanced Therapies

  Current Landscape of the Alopecia Treatment Market  

Alopecia is a condition that affects a significant portion of the global population, impacting not only on physical appearance but also on self-esteem, mental health and overall quality of life. Studies have shown that affected individuals often experience increased levels of anxiety, depression and social withdrawal due to negative self-perception. The psychological impact is particularly marked in young subjects who are more likely to struggle with self-confidence in social contexts. Furthermore, emerging evidence suggests that hair loss is associated with an increased risk of scalp melanoma and with the risk of developing metabolic syndrome. A higher quality of life which allows a higher focus on physical aspects as well as exposition to stressful agents which can enhance hair loss, are responsible of a higher demand of therapeutic solutions. A multidisciplinary approach which considers all these factors is crucial in order to improve subjects’ conditions. Current market is aware of these needs and aims to offer solutions considering all the aforementioned concomitant disorders. 

According to American Hair Loss Association, published data reported that over 95% of hair loss in men is caused by androgenetic alopecia. Similarly, International Society of Hair Restoration Surgery reported that nearly 40% of men shows some degree of hair loss by the age of 35 years old, 65% at 60 years old, 70% at 80 years old, and 80% by the age of 85. Moreover, around 2% of the global population is at risk of developing alopecia areata in their lifetime. Considering these factors, androgenetic alopecia market size in terms of revenue is estimated to grow significantly during the forecast period.

The global alopecia treatment market has showed a sustained growth during last years. In 2023, it was valued at $8.77 billion and currently a compound annual growth rate of 9.1% is projected. This rise is driven by factors such as the increasing awareness of available treatments, technological advances in trichology and a rising demand for aesthetic solutions.

  Conventional Market Treatments: Benefits and Limitations  

Traditional therapeutic options for alopecia include:

• Minoxidil: topical vasodilator that promotes hair growth and enhance blood flux in hair follicles. Although effective, continuous application is required to maintain beneficial results and side effects such as scalp irritation may occur.
• Finasteride: inhibitor of the 5-alpha reductase enzyme that reduces the conversion of testosterone into dihydrotestosterone, the main responsible androgen of androgenetic alopecia. It is associated with side effects like sexual dysfunction.
• Hair Transplant: surgical procedure that relocate hair follicles from donor areas to bald regions. Although it offers permanent results, it is invasive and costly.
• Platelet-Rich Plasma Therapy:  regenerative treatment against hair loss that has gained popularity due to its potential for stimulating hair follicle growth and improving hair density through platelets growth factors release. Platelet-Rich Plasma therapy involves concentrating platelets from patient blood resulting in a platelet-rich plasma which is injected into the scalp. Although it is a natural and well-tolerated option, its efficacy varies among individuals and requires multiple sessions for noticeable results and maintenance to sustain those benefits. Additionally, this therapy is costly and it is not covered by insurance.

  Emerging Therapies: A Promising Future  

The limitations of conventional treatments have prompted the development of new innovative therapies increasingly diverse, reflecting the complexity of hair loss conditions. Recent therapies focus on compensating cellular function loss, addressing androgen sensitivity, hormonal imbalances and genetic background and mitigating the microinflammation observed in patients with alopecia as well as aim to a long-lasting solution with minimum adverse events. Among these innovative approaches are:

Hair growth stimulators. They are believed to restore hair growth by reactivating dormant follicles and promoting a healthier environment for the scalp.

• Prostaglandin (PG) F2α antilogsues.  Prostaglandin analogues were originally used to reduce intraocular pressure in glaucoma and unexpected concomitant effects on eyelash growth suggested a specific effect on hair follicle activation. Bimatoprost, approved by the FDA for the treatment of eyelash hypotrichosis, is awaiting clinical validation for androgenetic alopecia. In addition, DLQ01, a liquid topical formulation of a prostaglandin (PG) F2alpha analogue, is being clinically investigated (Phase2A).
• Multiple pathway activators involve in hair cycle: AMP-303 and AMP-506 are known to act on multiple pathways involved in hair follicle cycling and regeneration and therefore may stimulate hair follicle regrowth. They are currently being investigated in clinical trials.
• Prolactin receptor blocking antibody: Because prolactin promotes catagen in the hair cycle, blockade of the prolactin receptor may promote hair growth. A monoclonal antibody targeting the PRL receptor (HMI-115) is under assessment in several clinical trials with promising results, as this antibody almost doubled the number of terminal hairs in animal models.
• Thyromimetic drug: TDM–105795 is a small molecule being developed as a topical drug and it is believed to stimulate hair growth in a dose-dependent manner when applied topically as previously shown in animal models. It is currently being tested in clinical trials.

Androgen blockers:

• Selective androgen receptor inhibitors (SARIs): targeting androgen receptors in the scalp thereby inhibiting the effects of androgens on hair follicles is currently being studied for the treatment of androgenetic alopecia. Breezula ® (Clascoterone solution), showed promising results after 12 months treatment in a phase II clinical trial. Currently, phase III trials are being under evaluation. Its localized action Reducing the risk of systemic side effects, positioning it as a promising solution for androgen-related hair loss.
• Selective inhibitors of the 5α-reductase type 1 enzyme:KX-826 is a topical treatment that has been tested in Phase 2 clinical trials. Early results have shown promise, with patients demonstrating improvements in hair count and density compared to placebo.
• CosmeRNA ARI (ARI, androgen receptor inhibitor) CosmeRNA ARI, which uses self-assembled micelle inhibitory RNA technology to inhibit androgen receptor mRNA, is applied topically and selectively targets the androgen receptor, effectively downregulating its overexpression and significantly increasing hair growth, as reported in clinical studies.

Targeting Immune-related pathways: JAK Inhibitors: Originally used to treat autoimmune diseases, these inhibitors have shown beneficial outcomes in treating alopecia areata, a condition characterized by patchy hair loss. The FDA approved Baricitinib as the first systemic treatment for severe alopecia areata and, more recently, Ritlecitinib, which has shown promising results, also in severe alopecia areata.

Cellular based therapy 

• By administering cells to the scalp, this approach focuses on the regeneration/reactivation of hair follicle (HF) by restoring miniaturised HFs into fully developed terminal HFs. Different cellular products have been used in the treatment of AGA<

Stromal Vascular Fraction (SVF) extracted from adipose tissue, micrograft solutions, dermal papilla cell-based, like expanded autologous dermal papilla, or dermal sheath cup cells are some of the cell products administered and being currently used in clinical trials. Promising results have been observed hence holding an innovative approach for treating AGA.

Other treatments:

• Drug delivery technologies:

Liposomal formulations, hydrogels and nanotechnology-based carriers are being designed to enhance dermal absorption and minimize systemic adverse effects while ensuring long-lasting effects. A long-acting injectable Finasteride formulation in lipid nanoparticles has shown pharmacological efficacy using monthly administration although long-term acting formulation presented some systemic side effects. Currently early phase clinical assessments are being undergone. 

Low-Level Laser Therapy: a non-invasive treatment that uses low-intensity laser which stimulate hair follicles. Clinical trials have shown its efficacy in increasing hair density in individuals with androgenetic alopecia.

  The Role od AGACELL-19 in the Advanced Therapy Landscape  

Within this context of innovation, the AGACELL-19 project emerges as a pioneering initiative aimed at developing a new advanced therapy medicinal product (ATMP) based on allogeneic mesenchymal stem cells combined with a molecule energy booster for the treatment of androgenetic alopecia. This therapeutic approach seeks to provide a safe and effective alternative to existing treatments, addressing the current gaps in efficacy and durability. The internationalization plan for AGACELL-19 focuses on maximizing the global impact of the product, ensuring its commercial viability, and strategically positioning it in key markets. The strategy includes:

• Scientific Communication. Publishing results in high-impact journals and presenting at international conferences to engage the scientific and medical communities.
• Industrial and Commercial Outreach<. Participating in technological fairs and organizing specialized webinars to attract industrial partners and investors.
• Regulatory Compliance Adapting to local regulations in target markets and obtaining necessary certifications to facilitate market entry.
• Strategic Collaborations Ebuilding partnerships with global entities to enhance research, join forces and expand market reach.

  Conclusion  

The landscape of alopecia treatment is undergoing a significant transformation, driven by an increasing demand of more effective and long-lasting solutions. Advanced therapies, such as those currently under development in the AGACELL-19 project, represent a promising therapeutic solution for subjects with androgenetic alopecia pursuing niche restoration and hair follicle intrinsic mechanisms enhancement By integrating cutting-edge scientific research with strategic market positioning, these innovative treatments will have the potential to redefine standards of care in alopecia management, offering renewed hope to millions of people affected by this condition worldwide.