The Central Role of Fibroblasts in Androgenic Alopecia: A Systematic Umbrella Review

    July 2026 in “ Cell Transplantation
    Shanshan Yu, Jie Ji, Yingying Wu, Jingyun Li, Jingyun Li, Hui Yan, Yongfang Xu, Yutong Shi, Jun Li, Jun Li
    This systematic umbrella review highlights the central role of dermal papilla (DP) fibroblasts in the pathogenesis of androgenic alopecia (AGA). The review synthesizes evidence from 43 articles, revealing that DP cells express high levels of androgen receptor and 5α-reductase type II, which, upon activation by dihydrotestosterone, lead to several detrimental effects: downregulation of Wnt/β-catenin signaling, upregulation of TGF-β/BMP pathway, altered secretion profiles, impaired DP cell aggregation, destruction of hair follicle stem cell activation, and induction of inflammation and fibrosis. These findings underscore the dysfunction of DP cells as a key driver of hair follicle miniaturization in AGA, suggesting that targeting DP cell dysfunction could be a viable therapeutic strategy. Evidence regarding the role of dermal sheath cells as a DP cell reserve remains limited.
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