Biocellular-Cellular Regenerative Treatment Scaring Alopecia and Alopecia Areata

The aesthetic surgical \& cosmetic discipline of hair restoration is rooted in numerous landmark studies and progressive medical science in the medical literature. With the advent of advanced theories and science using cellular and platelet-derived growth factors within the scope of regenerative medicine, have been well established in a number of peer-reviewed publications, The use of biological modalities, e.g., HD-PRP concentrates (defined as > 4-6 times patient circulating baselines), have become recognized in a number of disciplines, including value of stimulation of scalp tissues and hair follicles in androgenetic alopecia (AGA). (See Clinical Trial Study STRAAND). A "retrograde" filling technique creating a potential space and subsequently injecting into this space will insure uniformity of placement and spread of the delivered treatment modality.

This study design is intended to be a prospective, randomized, multi-center trial with blinding of outcomes for independent observers, clinical provider, and patient observation/satisfaction study comparatives. The study proposes adipose-derived cellular and stromal components when mixed with platelet high density concentrates (HD-PRP) offers an advantage to produce a markedly more effective therapeutic profile in in treating patients with scaring alopecia's (SA) and alopecia areata (AA), tissue age related senescence, and encourage vascular capabilities by stimulation of vasculoneogenesis. The benefits of using autologous adipose-derived stem \& stromal cell (ADSC) populations are cell proliferation and vasculogenesis that is intrinsically linked with native inflammatory modulation and immunomodulatory capacities. Reports describing the safety and efficacy of this biocellular combination have been reported in peer reviewed literature.

In the second and third arms of this study, use of regenerative protocols currently being extensively been utilized in the treatment of degenerative musculoskeletal conditions and plastic surgical procedures have been safely and effectively employed. These protocols feature the use of an emulsified AD-tSVF + HD PRP (ARM 2) compared to use of emulsified AD-tSVF + AD-cSVF (cell enrichment) + HD PRP (ARM 3) containing the full heterogeneous stem/stromal cell population and its native bioactive matrix. Addressing regions of scalp dermis containing the microenvironment (niche) of the hair follicle, progenitor tissues ("bulge").

In ARM 3, addition of cellular enrichment of the emulsified AD-tSVF is accomplished via a semi-automated, closed sterile system (Healeon CentriCyte 1000 system) which effectively isolates and concentrate the cellular elements. The AD-cSVF is then mixed with high-density platelet rich plasma (HD-PRP) concentrates with emulsified AD-tSVF tissues prior to targeted scalp injections. This injected cell-enriched product contains the bioactive native adipose tissue scaffolding, autologous HD-PRP, and cell-enriched adipose stem/stromal cellular concentrations of stromal/stem cells.

In ARM 4 of this study, the addition of intravenous cellular deployment of isolated cSVF is performed following without direct injection to scalp sites. Observations in other trials have suggested that increased hair growth in shaft size, coloration and speed is noted in the majority of parenterally treated patients as an observed effect of infusions. In the future, clinical trial extension of this study will combine both the components shown in ARM 3 and add a concomitant ARM 4 to evaluate potential of stimulation of proliferative and regenerative potentials in the form of combined therapy.

It has been noted by several investigators that parenteral us of AD-cSVF has had an unexpected outcome of improve hair growth and color change. All of the study ARMs (with exception of comparative control ARM 1) are tested by flow cytometry for viabilities and numbers, which will be statistically compared to outcomes following the study completion to examine whether a statistically significant difference in results follows with each ARM can be shown.

The goal of this study is to demonstrate the safety and efficacy of each ARM. Biocellular injections into the scalp of men and women with a diagnosis of scaring alopecias and alopecia areata, with full reporting of AE and SAE (adverse events). In the intradermal injection portions of the study, the biocellular material is injected 3-5 mm in depth within the mid-reticular dermis to upper subcutaneous fat layer of the scalp. Placement of the biocellular and cell-enriched biocelluar is intended to examine changes associated with changes of the miniaturized hair follicle. It is hypothesized that delivery a milieu of stroma and stem/stromal cells will facilitate regenerative changes of the treatment sites. In addition to providing native bioactive tissue scaffolding, and a greater number of stromal/stem cells to the tissues surrounding the follicular niche will result in a positive effect.

Use of small needles for delivery is made possible with incorporating the novel use of emulsification of adipose tissue complex (lipoaspirates) This emulsified AD-tSVF and HD PRP methodology reduces surgeon injection pressure requirements resulting with use of smaller gauge needles. When clinically compared to the use of much larger needles required to inject non-emulsified AD-tSVF, it is an improvement on current techniques. A "retrograde" filling technique creating a potential space and subsequently injecting into this space the biocellular material as the needle is withdrawn is advanced in this study.

Successful stem/stromal cell-enrichment of AD-tSVF and HD PRP biocellular mixture has been reported in numerous peer-reviewed and published clinical experiences of injections for structural tissue augmentation in plastic surgery, chronic wound therapies, and ultrasound guided musculoskeletal treatments in orthopedic \& sports medicine.

Standard venipuncture for obtaining circulating whole blood is concentrating platelet components to create a low hematocrit HD-PRP using FDA approved E USA) Emcyte II following manufacturer's guidelines. Small volume closed syringe microcannula lipoaspiration is used to acquire AD-tSVF tissues(Tulip Medical GEMS, San Diego, CA,, followed by emulsification via the Healeon ACM System (Newbury Beach, CA, USA. Cellular testing of samples in Arm 2-4 will be performed by flow cytometry (ORFLO, MoxiFlow, Ketchum, ID, USA) for viability and cell concentrations.

A detailed patient medical history, study informed consent, and screening evaluations will determine eligibility and candidacy for the study and complying with the inclusion/exclusion criteria.

Recording of the platelet pre-operative measured baselines and achieved HD PRP concentrates, flow cytometric examination of cell viability, and cell counts of AD-cSVF should be completed on each patient. Biocellular injections and treatment will be given on two (2) separate procedures three (3) months apart. Follow up clinical examinations are to be performed at 6 months and 1 year period with completion of outcomes analyses including independent observer, clinician, and subject satisfaction. The volume of the therapueutic mix will be the standardized in volume for all trial ARMs.

Immediate reporting to the study group for all AR and SAR will be documented and recorded for the safety records directly to Ken Williams, DO, as Co-Principal Investigator. This Clinical Trial will have a sample size of 60 patients at up to six (6) centers utilizing this protocol.