Hair Restoration Blog

Q:

Hello Dr Mohebi,

I recently read an article on the web that you commented on Harvard research for hair cloning.  I am in my early 40′s, fairly broke, and eagerly awaiting the day that hair cloning is successful and available to the market.  For the past decade, I keep hearing the same promises that it will arrive in 5 years, but still no luck.  Can you comment on why it is not here yet, and perhaps when we will see it.  Thanks in advance.

A:

Hair multiplication also referred to as “Hair Cloning” is a hot topic in hair restoration over the last few years it is garnering more and more attention.  The research for multiplying hair (hair cloning) has been going on for years now in several centers around the world over the past few years.  The study that we performed with collaboration with some scientists in Cedar Sinai is only one of the many steps that need  be taken to successfully multiply hair.

Hair multiplication would offer superior benefits to patients and represent a significant advance for medical science and hair restoration. Still the march towards this being a medical reality moves slowly for a several different reasons:

1.  Although hair loss has detrimental effects on patients’ lives, is yet to be recognized as a burning issue in medical field to warrant more funding for hair loss research.
2.  Hair multiplication studies are usually done in private setting without the support of larger institutions such as universities and NIH (National Institute of Health).
3. The growth rates of the hair stem cells are extremely slow in cell cultures.  That makes the overall period of hair multiplication timelier and adds exponentially to the cost of these studies.

The combination of above three factors and other obstacles in this process has made progress of hair multiplication very slow.  My best estimation of current research is that hair multiplication is probably at least 8 years away from practical medical application.  The reason for this is that any new medical treatment or device needs to go through different phases to obtain FDA approval for its use in the U.S.

The last phase necessary in development of a new treatment is ‘clinical trials’. The phase three is done on volunteer patients to find out more about long term complications that might be associated with the treatment. At this time no study has reached the clinical trials stage this makes it unlikely that we can have hair cloning available to public within the next eight years.

Hair stem cell and its role in future of hair restoration has been a hot topic in recent years. Hair multiplication also referred to as hair cloning is a process of culturing cells responsible for development of hair follicles. This is necessarily done by generating new hair in refined laboratory conditions.. The concept is that then those hairs manufactured hairs could then be transplanted for hair restoration purposes. It is easy to understand how success in the area of Hair Multiplication would be another quantum leap in hair restoration. People affected by patterned baldness could have the stem cells of hairs from their permanent zone multiplied for hair transplant.

A new article was published in e-Publication Development by Chi W. et al. This article reviews a critical stage of hair development regarding which one of the two hair stem cells is most important for size and shape of new hair.

Dermal Papilla (DP)

Dermal papilla (DP) develops a new hair. The DP is located in the hair bulb. Dermal papilla’s interaction with stem cells from the bulge area leads to generation of a new hair. Laboratory tests on mice indicates that the number of DP cells in the follicle correlates with the size and shape of the hair produced .

The study of mouse model allowed for selective ablation of DP cells in-vivo. The result of the study demonstrates that

• DP cell number dictates the size and shape of the hair.
• DP cells help develop hairs of different sizes or types.
• The number of DP cells plays a critical role in the size of hair shaft that will get developed.
• DP cells play an important role in activation of stem cells leading to the formation of new hair shafts.

These scientists also observed that when the number of DP cells fall below a critical threshold, follicles fail to develop new hairs. Based on this new development, it is easy to understand the mechanism of degeneration of hair in hair loss situations in relation to a drop in the number of DP cells.

Reference:

Chi W, Wu E, Morgan BA. Dermal papilla cell number specifies hair size, shape and cycling and its reduction causes follicular decline. Development. 2013 Mar 13, http://www.ncbi.nlm.nih.gov/pubmed/23487317

There is an increasing buzz throughout the medical world that is filtering down to the public regarding the possible benefits from stem cell medical treatments. Hair Restoration is not immune to the excitement that perhaps hair loss would be remedied in the near future from such an innovative medical treatment.

In my time as a research fellow at John Hopkins University Medical School, I had the opportunity to conduct research in the area of stem cells and hair growth. At this time I find it important to provide patients and the general public some basic knowledge of stem cells and regards to the possible effect on hair growth or alleviating hair loss.

Mesenchymal Stem Cells

Mesenchymal stem cells are pluripotent stem cells that are derived from the mesoderm and are destined to differentiate into a variety of connective tissue cells.

Mesenchymal stem cells (MSCs) are generally responsible for making cells in bone, cartilage and fat tissue. A new study performed by Department of Histology and Embryology and Research Center of Developmental Biology Military Medical University in Shanghai that was conducted shows that Dermal Papilla cell which is one of the two types of hair stem cells is involved with the production and growth of a new hair (dermal papilla) could be also made from MSCs. The study was performed by Wu et. al proves that hair follicles could be made from other types of stem cells and not only specific hair stem cells.  This concept could be a milestone in hair stem cell, hair multiplication or hair restoration fields.

These scientists discovered that Human Mesenchymal Stem Cells that usually make other cell lines in human posses the potential to differentiate into DP or hair stem cells in lab or in human scalp. Does it mean we can harvest a small amount of fat from a patient and transform it into hair follicles and implant them into a balding scalp?  We need to have more evidence on the efficiency of this type of stem cell therapy through future research.

As advancements in stem cell research and procedures become known I will endeavor to continue US Hair Restoration’s efforts to be at the forefront of resolving hair loss for our patients.

Report of ISHRS 20th Annual Scientific Meeting

OCT 17-20 2012– Atlantic City, Bahamas

The annual meeting of International Society of Hair Restoration Surgery is the most significant hair restoration meeting worldwide.  This year’s meeting was one of the best in terms of the content of the information discussed.  The meeting was held in Atlantic City, Bahamas.

Hair Restoration Surgery is evolving rapidly with newer technologies that enhance our understanding of hair growth and the tools that help us expect better growth. This year’s conference hot topics had five areas of focus. These topics are reviewed below:

Robotic hair restoration

ARTIS or Robotic Hair Transplantation was actively promoting its robotic arm that helps the surgeon to extract the FUE Grafts for hair transplantation.  The Robotic hair transplant update for 2012 was not as significant as many attending physicians anticipated.  Considering that the robotic hair transplant is being promoted and used in several offices actively for over a year, most surgeons expected to learn more about the scientific evaluations that can differentiate robotic procedures with other techniques of hair restoration.

The doctors who used robot in their offices in the last year discussed their personal experience with robotic hair restoration.  Some discussed that the numbers of grafts have been improved, but there was not a significant evaluation on the quality of grafts to other methods of FUE hair harvesting or to compare the robotic grafts with grafts from strip hair transplants.

Stem Cell and hair multiplication

We have had a few discussions about new advancements in Stem Cell research in 2012.  Some of the familiar faces gave lectures about the status of hair stem cell research and where we are standing on hair multiplication.  At present it appears  that no one has started the phase III level of research.  In practicality this means we are unlikely to be able to have a way to multiply hair in the next 8 or 10 years. Until we hear the phase III level of hair multiplication studies are successfully completed our patience and our practices will be reliant on our present hair restoration methods.

FUE transplantation

Many doctors discussed the increased rate of FUE hair transplantations worldwide.  However, comparing different countries, it is apparent presently FUE is being used mostly in Asia and Europe in comparison to the United States.  I (Parsa Mohebi, MD) presented result of the study of the effects of delay in extracting follicular units on viability of FUE grafts.  I have discussed the conclusion of our study on 3 patients in which FUE grafts were initially punched and then removed in 5, 30, 60 minutes and 4 hours.

This study was the only study conducted  to compare the in-situ viability of the follicular unit grafts.  The study showed that keeping the punched grafts in scalp longer than a few minutes may decrease the survival of the grafts. The results of this study may help the design of the next generation of FUE devices and robotic surgery to try to be more efficient with the time that grafts are punched and before they could be removed from the scalp.

Methods for improving the aesthetics of hair restorations

I had another presentation on the advantages and disadvantages of extracting hair from temporal areas.  I have brought up the “Mad Scientist Phenomenon” which refers to the situations that hair transplant surgeons harvest maximum number of grafts from the donor area on the back and not take any hair from temporal areas in patients who have a high density of hair on the temporal areas. The thickness of hair on the temporal areas may undermine the drastic changes that a hair transplant may have on restoration on the front and top areas.

Finasteride Controversies

Dr. Washenik from Bosley discussed the controversies around finasteride (Propecia).  He discussed the persistent sexual dysfunction controversy and a Canadian lawsuit that could not link the side effects to the medication.   Dr. Sharon Keen discussed that the studies that reviewed the permanent side effects of finasteride did not have adequate objective evaluation of health status in those patients.  There were also some discussions about other side effects of finasteride such as the DHT blocking effects on increased production of testosterone and estrogen that may lead to gynecomastia (enlargement of breast tissue in men).

Hair stem cell research is one of the most promising areas for hair restoration in the future.  Currently there are many advanced techniques for hair transplantation; however a long journey remains in order to provide hair loss sufferers with an unlimited source of hair, and stem cells might be an answer to this need.  In the past we have reported in our blogs of the newest advances in hair restoration through stem cell research from our own research and that of other centers.

A new article published in the Journal of Dermatology Science in February of 2012 sheds fresh light on the subject.   Authors, Dr. Chen and Dr. Chuong from Taiwan reported on the type of environment hair stem cells require in order to produce new hair.  Hair Stem cell circulation has been thought to be regulated by signals from the micro-environment which is close to them in skin tissue named the “stem cell niche”.

The authors proposed recent studies which reveal that there can be multiple layers of environmental controls. These environmental controls were reviewed using the paradigm of hair stem cells. This is because in order to properly observe and analyze hair growth, it is easier to see their regeneration pattern characteristic that occurs on a regular basis in different phases.

The duration of hair growth determines the actual length of hair fibers. We now know the generation of a new anagen hair is a result of the interaction between the two different stem cells in each hair follicle.  Hair stem cells located in the bulge of the follicle interact with signals from the dermal papilla to produce a new hair.

The activation of hair stem cells has been shown to be modulated by molecules secreted from the intra-dermal fatty tissue as well as other hormonal signals, immune reactions, neural activities, and the aging process. The general physiological status of individuals is further influenced by cyclic rhythms and changing growth periods. The interactive networks of these environmental factors provide new understanding on how stem cell homeostasis is regulated.

The authors also discuss the environments which are involved in order to make new hair.  My hope is that as we become more aware of the circumstances involved in hair growth and development, we can develop more practical ways to use advanced stem cell technology for hair restoration.  The optimal solution for hair restoration might not be through the multiplication of hair stem cells, however increased knowledge on the environment which hair follicles grow can lead to procedures that reactivate the existing hair stem cells that are progressing toward miniaturization and eventual baldness.  Many physicians believe balding does not permanently affect hair follicles; rather the bald follicles keep their potential to be reactivated and grow healthy hair. This is of course, as long as the right environment is provided for the hair follicles to grow.

Minoxidil (Rogaine) is one of the two proven treatments for hair loss along with hair transplant. Although minoxidil mechanism of action for hair growth is not fully understood, there have been several suggested mechanisms such as:

• Nitric oxide chemical agonist effect impactig scalp blood vessels
• Potassium channel opener causing hyperpolarization of follicles cell membrane
• Vasodilation possibly due to its nitric oxide effect

This new study is done in Department of Immunology of Kyungpook National University in Korea. The result of the study was published in The Journal of Dermatological Science shows a new mechanism for minoxidil as activator of β-catenin pathway in human dermal papilla cells, one of the two stem cells involved in development and growth of hair. The investigators announced that this mechanism could be an explanation for anagen prolongation effect of minoxidil.

The length of the actively growing hair in anagen phase (growth phase) is responsible for hair length. The investigators indicated that maintenance of β-catenin activity in the dermal papilla cells (DPCs) enables hair follicles to keep growing actively. Minoxidil or Rogain promotes hair growth in male patterned baldness suggesting that minoxidil can prolong the growth phase in hair life cycle.

The study is done in mouse model with application of 3% minoxidil for ten days. DPCs were transfected with β-catenin responsive TCF reporter plasmid. They showed that extension of anagen phase was significantly promoted after minoxidil application. The researchers concluded that minoxidil extends the anagen phase by activating β-catenin activity in the DPCs and that can be one of the main pathways in its hair growth or hair loss prevention mechanism.

Studies like this increase our understanding of hair loss and hair growth and over time can help hair restoration field to have more options to fight hair loss in a more efficient way.

Q:

Hi Doc! How are you?

I have question regarding my hair loss problem. I’ve noticed it just 3 weeks back. As I’ve been reading your infomercial regarding the causes of hair loss. I think I am categorizing my problem to Alopecia Areata where I have one circled affected areas on the right of my front hairline & 2 at the right side at the back of my head. Before that it was small and now it is becoming bigger day by day.

Hope you could help me to find a solution of my problem. Thanks a lot! Hope to hear from you soon!!!
More power!!!

A:

Alopecia areata (AA) in its typical form is easily distinguished from typical patterned male and female hair loss.  Obviously, you need to be examined by a hair specialist or a dermatologist to confirm the diagnosis.  Alopecia areata generally present itself with a patchy or circular (coin shaped) balding spot and could be seen in almost anywhere in the skin.  The lesions are confined to their primary spots with no sign of hair loss in neighboring areas.  Some authorities have recommended steroid injections to facilitate the improvement of the lesions.  However, spontaneous recovery is seen in most patients with no interventions.

In contrast, hair loss pattern in male or female patterned hair loss is more widespread with the hair miniaturization (thinning) advancing to the neighboring areas.  Hair transplantation is not indicated in alopecia areata while it could be the only permanent solution in most cases of patterned baldness.

Q:

Is Hair cloning or multiplication being done anywhere yet?

A:

Hair cloning or multiplication has been in the news in the last few years. I prefer to use the term hair multiplication, rather than cloning because cloning refers to production of genetically identical organisms. Dolly the most celebrated sheep was the product of first cloning. When it comes to hair, we do not really clone the cells, but we culture them and try to get a whole organism from cultured cells. Unfortunately the process of culturing hair follicle cells has not been as simple as some other tissues in human body. The complexity of hair physiology is due to participation of many different stem cells in development of each hair follicle. In this process, we do not multiply genetic material or DNA of cells.

Hair cloning news

Hair multiplication if become a reality could bring about a great opportunity for bald people with violated donor scalp who cannot be good candidates for hair transplantation with current techniques. Despite our enthusiasm about hair multiplication, hair cloning news in last few years has not been filled with many success stories.

Hair cloning 2007

Year 2006 intercytex company announced that they are going to start phase 3 of hair multiplication study soon. Hair cloning has been in the news and many people are eagerly following that news to see when and how they can get a full head of hair using hair cloning techniques. Unfortunately, cloning hair has not been going that well and in last few years we only had limited research results on hair multiplication in animal models and in human. Here is the question that people usually ask me: Is hair cloning being done anywhere yet? And my answer usually is: Not except on experimental levels. Several investigations are in process on hair multiplication field and hair stem cell research.

Hair cloning 2008

Hair multiplication or as people call it hair cloning is a method that allows us to culture hair follicles and multiply it so we can increase the final number of hairs. So far, we know that it is doable on animals, and there are some reports of its feasibility on human volunteers. Safety has been one of the biggest questions on any research involved with stem cells. Stimulating growth of stem cells has always raised the flag for possible tumor formation. In year 2008, we should witness some results of the phase 3 studies on the procedure. During this year or in next few years, we should have a better understanding of the effectiveness and safety of hair multiplication. I know many of my patients are following hair cloning news carefully. Unfortunately, hair multiplication news has not been very fruitful in last year, but the process is complex and one way or another it will become clear in next few years that we can or cannot use hair multiplication methods in hair restoration surgeries.

Question:

Hello,

I’m very interested in learning about the future methods and advancements in the science of hair restoration as you may have guessed. Is there an “on line” information source you could direct me to, in order to keep of with the current work on stem cell progression, and the like? I have ushairrestoration.com site, of course, because it’s on your card. But am at a lose as how to get more information. Is there a site that publishes research papers and cases studies of new developments?

Answer:

I am not aware of any site that is dedicated to the advancements on stem cell research, but there are some sites that you can get good information on hair restoration and possibly get yourself familiarized with the new surgical and medical methods to restore hair. One that I recommend is the website of the International society of hair restoration surgery. It may not be updated very often, but is being fed through many different sources and could be a good source of information for someone like you to get some general information. Of course if you are interested in more scientific articles, you can use the National Center for Biotechnology Information, which gives you the most recent publication in most medical journals. This site is searchable for different criteria so you can put your keywords in and see what new information is out there.

Cicatricial alopecia refers to a group of rare skin diseases in which hair follicle get destroyed and replaced by scar tissue. It is one of the rare causes of hair loss. Hair loss could be gradual or sudden. Hair loss could be without any symptoms or it could present with sever itching, burning and pain. There is usually no visible scar, because the inflammation is below the level of skin. Cicatricial alopecia could occur in otherwise healthy men and women of all ages.

Cicatricial alopecias could be primary or secondary. This discussion is confined to the primary cicatricial alopecias in which the hair follicle is the target of the destructive inflammatory process. In secondary cicatricial alopecias, a non-follicle-directed process or external injury, such as severe infections, burns, radiation, or tumors could cause destruction of the hair follicle.

The causes of the cicatricial alopecias are not completely known. However, all cicatricial alopecias involve inflammation directed at the hair follicle, the upper part of the follicle where the stem cells and sebaceous gland are located are generally involved. Permanent hair loss occurs when the stem cells and the sebaceous glands are destroyed. This type of hair loss is usually irreversible.

Cicatricial alopecias can affect both men and women. The majority of patients with cicatricial alopecia have no family history of a similar condition. Central centrifugal cicatricial alopecia is a type of cicatricial alopecia that is more prevalent among black woman. Frontal fibrosing alopecia on the other hand is seen most commonly in post-menopausal women and could be seen in association with chronic skin conditions such as lupus erythematosus and in people with personal or family history of autoimmune disorder. A scalp biopsy is necessary for diagnosis of cicatricial alopecia. Presence of inflammatory cells and scarring could be diagnostic and essential for determining the type of treatment.

Treatment of the lymphocytic group of cicatricial alopecias involves use of anti-inflammatory medications such as steroids, cyclosporine, hydroxychloroquine. When hair follicle destroyed, hair will not grow back. However in some cases using minoxidil solution can help to stimulate growth of some of the remaining hair.

Hair transplant could only be used in the patients who have normal healthy hair on donor area without any microscopic or macroscopic evidence of cicatricial alopeica activity.  If hair multiplication becomes a reality it might potentially be a good option for patients who lost their scalp hair extensively as result of cicatricial alopecia.