Novan, Nitric Oxide, Acne and MPB

Recently, reader “John Doe” brought to our attention a US-based biotechnology company named Novan. Their work in developing a topical nitric oxide based product for male pattern baldness (MPB) seems quite unique and is worth a post.

Novan, SB204, Acne and Hair Loss

Novan (sometimes also called Novan Therapeutics) is developing a number of dermatological products. Per its pipeline, their acne vulgaris product SB204 is already in stage 3 clinical trials. This is the same product that can also be used for hair loss.

However, unlike Cassiopea (Breezula for MPB and Winlevi for acne), Novan is not undertaking separate trials for its hair loss product. The company does list androgenetic alopecia as a potential therapeutic application of nitric oxide at the bottom of its pipeline page.

Perhaps the assumption is that if Novan’s topical nitric oxide (NO) based SB204 product for facial acne is proven safe, it can also be used on heads? And this can be done without necessitating FDA approval for such off-label use? In any event, who can prevent someone for getting a prescription for SB204 for acne, but then using it on their head instead?

Initially, I thought that Novan was a new company. However, it seems like they have  been working on NO based drug candidate products since 2010.

Novan Pipeline Acne and Hair Loss
Novan’s nitric oxide based dermatological products pipeline.

Nitric Oxide and Hair Loss

Over the years, I have read about Sildenafil (Viagra) impacting nitric oxide pathways and temporarily curing erectile dysfunction. The vasodilatory effect from Sildenafil relaxes and widens blood vessels. I have also heard about nitric oxide’s important cardiovascular impact. In 1992, NO was voted as the molecule of the year.

However, I have not paid much attention to nitric oxide levels on the scalp and their impact on hair loss. One clinical trial in China that ended in 2013 compared the safety and efficacy of nitric oxide gel in promoting hair growth in men. No results were posted.

According to this excellent paper from Novan’s Dr. William Kelce, nitric oxide on the scalp or skin can inhibit skin steroidogenesis. This results in reduced levels of key androgens testosterone and dihydrotestosterone (DHT). Nitric oxide also reduces sebum levels.

Even more interesting than its anti-androgenic effects, nitric oxide levels can inhibit prostaglandin D2 (PGD2) synthesis. See my past posts on the connection between PGD2 and balding.

It has been postulated that one of the ways in which laser hair growth devices benefit scalp hair growth is via stimulating increased nitric oxide levels. Moreover, it is thought that Minoxidil has the chemical structure of nitric oxide and may be a nitric oxide agonist.

Adipose-Derived Stem Cell Constituent Extract

It has been a while since I wrote a post related to adipose-derived stem cells (ADSCs) and hair growth. Adipose cells are also called fat cells.

Adipose‐Derived Stem Cell Constituent Extract

A potentially groundbreaking new study from South Korea was published yesterday. Thanks to Chris and Joe who both e-mailed me with links. This study concluded that adipose‐derived stem cell constituent extract (ADSC‐CE) helps hair regrowth in patients with androgenetic alopecia.

Adipose-derived stem cell constituent extract (ADSC-CE) and hair growth.
Adipose-derived stem cell constituent extract (ADSC‐CE) treatment increased hair count and hair thickness in the study. © 2020 Tak/Lee/Cho/Kim — Stem Cells Translational Medicine, published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.

According to the authors, this is the first time that ADSC‐CE and its benefits on hair growth have been demonstrated via a a randomized, double‐blind, vehicle‐controlled clinical trial. Many other past studies have shown the benefits of ADSC (often via intradermal injections) on male and female pattern hair loss sufferers.

This latest study was widely covered in the media, including by the Daily Mail and New Atlas. The trial was conducted at Busan (Pusan) National University Yangsan Hospital and led by Dr. Sang Yeoup Lee. The actual trial was completed in 2016, so I am not sure why results were delayed till 2020.

The study was published in the journal Stem Cells Translational Medicine. The famous Dr. Anthony Atala is editor-in-chief of  this journal. He is quoted as saying that this treatment offers hope to hair loss sufferers.

ADSC-CE Before and After Hair Growth.
ADSC-CE hair growth photo at 8 weeks and 16 weeks. One of the four results presented in the study.

Hair counts (+28.1%) and hair diameter (+14.2%) both increased substantially in 34 patients who completed the study. Original patient enrollment was 29 men and nine women. Encouragingly, these results persisted 16 weeks post treatment, with no major side effects. The treatment entailed twice‐daily self‐application of an ADSC‐CE topical solution all over the scalp.

The authors assumed that ADSC‐CE is likely to penetrate scalp tissue more than existing products that are manufactured using conditioned media (ADSC‐CM).

Adipose (Fat) Cells and Hair Growth

A lot evidence on the benefits of fat cell injections upon hair has been accumulating over the past decade. Even as far back as 1954, there was a study published suggesting a connection between scalp thickness, fat loss and balding.

I have written around 10 posts in the past that cover ADSC and closely related subjects, although none in the past couple of years.

For example:

  • See my past post on Stromal Vascular Fraction (SVF) enhanced adipose transplantation and the STRAAND clinical trials.
  • And on Advanced adipose-derived stem cell protein extract (AAPE).
  • Also see my past posts on Kerastem and the company’s STYLE clinical trials.
  • I have also analyzed important work from Dr. Valerie Horsley’s lab regarding adipocytes and their essential role in  hair follicle regeneration. Last year, I also discussed fat layer loss and tightness in balding scalps.