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Exosome-Mediated Immunomodulation in Hair Regeneration: From Bench to Bedside

Wei Xinyu ORCID
Faculty of Medicine, University of Cyberjaya (UOC), Persiaran Bestari, Cyber 11, 63000 Cyberjaya, Selangor, Malaysia
Muhamed T. Osman ORCID
Faculty of Medicine, University of Cyberjaya (UOC), Persiaran Bestari, Cyber 11, 63000 Cyberjaya, Selangor, Malaysia

Received: 19 May 2025; Revised: 26 June 2025; Accepted: 3 July 2025; Published: 20 November 2025

Abstract

Hair loss still frustrates patients and doctors alike because available treatments yield only modest results; accordingly, researchers are pursuing fresh approaches that target the disorder at its biological roots. The study reported here examined how exosome-based immune tuning affects hair regrowth in mouse models and in ex vivo human follicle cultures. When delivered to skin in the telogen phase, exosomes from adipose stem cells (ADSC-Exo) and from dermal papilla cells (DP-Exo) rewired the local follicular immune environment, and regulatory T cells rose from 2.8 ± 0.5% to 9.1 ± 0.7%, M2 macrophages climbed from 12.4 ± 1.3% to 35.2 ± 2.8%, while potentially harmful CD8 T cells dropped from 28.6 ± 2.4% to 10.2 ± 1.1%. Cytokine profiling revealed a marked decrease in pro-inflammatory signals; hence, TNF-α decreased by 68% and IL-6 by 57%, while simultaneously showing a robust increase in immunoregulatory factors, with IL-10 rising 183% and TGF-β by 156%. The observed changes in immune cell activity appear to have emerged first and closely matched the improved indicators of hair regrowth; in particular, the fraction of regulatory T cells correlated very strongly with hair shaft length (r = 0.84, p < 0.001). Our data indicate that immune reprogramming acts as a central process in exosome-driven hair regrowth, thereby underlining the design of focused immunotherapies for different types of alopecia; however, additional clinical studies are still required.

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