 |
|
Dr. Bertram Medical Hair Transplant
眉 髮 醫 學 移 植 中 心 ( 香 港 ) |
( 852 ) 3421-1138
|
Future Development in Hair Loss Treatment
When discuss about Minoxidil or Finasteride for Androgenetic Alopecia (AGA), many patients asked, "Doc, do I have to take this for the rest of my life?"
The answer is a simply "NO". More and more people are suffering from hair loss, opening a huge product and service markets. Many enterprises are investing money to find the magic bullet. The development of the HairDx Genetic Test is a great step forward. Propecia and Minoxidil may soon be history.
One thing is important. According to Dr Van Neste the rescue hair diameter is 0.04mm. So any treatment must be started early to prevent the existing hairs from getting too thin and beyond rescue. Otherwise the future would have nothing to do with you. The followings are the current researches on hair loss treatment.
Dutasteride
This is one of the new drugs on the way to the market. Dutasteride belongs to the same family as Finasteride ( Propecia ) except more potent. Being an inhibitor of both type 1 and type 2 5a-reductase ( Finasteride only blocks type 2 ), its dual-enzyme inhibition decreases DHT by 90% to 93% compared to Finasteride 60%.
| |
Clinical Trials
 Dutasteride in previous clinical trials has been shown to be superior to finasteride in efficacy. While everybody is waiting the development of the drug for an AGA indication was stopped in USA, but shifted to Korea. A recent Korea phase III data showed Dutasteride 0.5mg ( dose for BPH ) showed significant results over placebo in 153 men at 6 months, and the side-effect profile was similar to Finasteride.
Indications
At present Dutasteride is officially prescribed for the treatment of benign prostatic hyperplasia, although a lot of doctors and patients have already been using it "off-labelled." We do not know when it will finally been approved by FDA for treating AGA. Read more about Dutasteride » |
Prostaglandin F2a Analogue
Drugs in this category are Bimatoprost (Latisse), Latanoprost (Xanatan), and Travoprost (Travatan).
| |
Mechanisms of Actions
This group was orginally prepared as eye drops in treating Glauma, a common eye disease. Farjo (UK) showed that human scalp hair follicles do express prostaglandin F receptors, with the possible role of PG agonists in stimulate hair growth.
Clinical Trials
Latanoprost was reported to length the eyelashes in 77% of patients after once-daily use for a mean of 4 months. Increase density, length, pigmentation and overall eyelash prominence can be noted within 4-8 weeks. It may work by direct growth stimulation or increase blood flow.
In a small study of 8 stump-tailed macaque monkeys – an animal model for baldness – latanoprost drop caused moderate-to-marked scalp hair regrowth when applied daily for 3 months.
Indication
Bimatoprost (Latisse) 0.03% solution was approved by FDA in 2008 for eyelash lengthing. It may soon be available in Hong Kong.
Other PG agonists are being tested for treating AGA. It may provide an alternative to androgen modulators such as Finasteride and Dutasteride. Main concern is the cost
Side effects
Topical application has no systemic side-effects. When used on the eyelashes, eyelid redness or temporal burning sensation were noted.
|
Hair Cloning
| |
Limited Donor Supply
Success of hair transplant is limited by the availability of donor hair. Hair donated from another individual will be rejected without use of immunosuppressant. Hair cloning has therefore been regarded as the future of hair transplant.
"Cloning"
A few hair follicles are first extracted from the occipital scalp. These follicles are then dissected to isolate the base of the root (dermal papilla). Each dermal papilla contains about 200-400 cells, which are cultured in laboratories to make several million offspring cells.
Cloning means producing an exact copy of a living organism. In this case only part of a follicle is re-produced. By definition “Hair cloning” is a misnomer. It should be called "hair multiplication" or "follicular neogenesis".
Use in Androgenetic Alopecia
In treating patients with male pattern baldness, these cultured cells are re-injected into the bald scalp of the same individual. Two possible actions happen :
- The cultured dermal papilla cells work with the local epithelial cells to induce new hair follicles formation
- The implanted cells are integrated with resident minaturized hair follicles, forcing them to reverse back into a full sized, terminal hair
Problems with Follicular Neogenesis
Turning this into practical use is full of problems. There is so far no study to prove that follicular neogenesis actually work in humans. Even the induced new hair follicles seen in experimental rodents
- were disorientated and grow at all sorts of angles
- appeared as unsightly clumps of growing hair
- survived only one hair cycle, unable to produce new hair
Clumps of induced new hair seen in an experimental rodent ( adapted from Dr Pathomvanich "Hair Restoration Surgery in Asians", chapter on cloning by Prof Kim of Korea )
Safety
There are safety concerns that these induced hair follicle cells, when grow uncontrolled, may turn into cancer. Approval from FDA will take a long long while.
More works are needed before follicular neogenesis can become a routine procedures that give consistent and acceptable results in humans. |
Wnt
| |
“wnt” refers to two different things :
- The wnt gene family - these are the structurally similar genes in humans that produce signaling proteins
- The wnt proteins - signalling protein produced by the wnt gene. Some of these wnt proteins are specific to certain cells and tissues
N.B. Above picture of the Wnt Pathway was downloaded From Wikipedia
Roles of wnt in Hair Growth
The wnt protein signaling molecules regulate cell-to-cell interactions during embryogenesis. They also control normal human physiological processes. Abnormal wnt signaling is shown to link to the development of various human diseases and cancer. Wnt signaling is critical for the followings steps in Follicular Neogenesis :
- Stem cell maintenance and essential at multiple steps during the organogenesis of the skin and its appendages
- Initial induction of the hair follicle
- Regeneration of hair, affecting its distribution, orientation, and pigmentation
Potential Use in Treating AGA
Wnt signaling may be used to treat AGA by modulating the hair growth cycle and follicle morphogenesis.
Clinical Trials
A current hair regrowth study were conducted by Drs. Craig Ziering and Perez-Meza. 24 patients with hair loss were recruited. 0.1cc of wnt proteins and different growth factors was injected into the mid dermis.
Result
only a single application of therapy is required to achieve an increase in new follicles; plus the thickness and number of existing hairs.
Mass Production of Wnt Protein from Human Fetal Fibroblast
Fibroblasts derived from neonatal foreskins following routine circumcision has been used to culture Wnt Protein. Under controlled conditions that duplicate the environment of the body, the fibroblasts can increase the production of wnt proteins, specifi cally wnt 7a, and other hair-regeneration-related proteins ( such as follistatin ).
During the production of wnt proteins, the cells also secrete a variety of wound healing growth factors, such as KGF and VEGF, which play a role in hair growth. All these when injected into the scalp may promote hair growth.
|
Stem Cell Injection Therapy
| |
The Stem Cells
Stem cells have the potential to turn into whatever cells in need. In hair follicle, stem cells are located in the mid-portion, the bulge. It is now known that even in a vellus hair, its stem cells are still intact. Re-activating these may have the potential in hair follicles rejuvenation and re-pigmentation. How to stimulate these stem cells become a hot research topics. One approach is the injection of stem cells from another sources to "synchronous".
Cheapest Source of Stem Cells
Stem cells can be obtained from bone marrow and cord blood. But the cheapest and most abundant source is actually human fat. In view of the abundance of adipose tissue, abdominal wall fat aspirate provides a definitive source of stem cells.
Stem cells extracted from abdominal fat have been successfully used in treating diabetes, coronary heart disease, stroke, breast augmentation etc. The use of own body stem cells also prevent the many problems of rejection.
Fat Stem Cells and Hair Restoration
There has been an unofficial report from Dr Kim in Korea. He claimed success in using fat stem cells in restoring thinning hair in over 30 cases. Stromal Vascular Fraction (SVF) isolated from body fat is believed to be important in hair restoration.
A commercially available kit is required which contains a lipo-dissolve component and an activation component. SVF are extracted in five steps :
| |
Step 1 : Fat extaction
Liposuction of the lower abdomen was performed to obtain adipose cells aspirate.
Step 2 : Seperation of SVG
The lipo-dissolve component from the kit was added to gently separate the SVF from the lipo-aspirate.
Step 3 : Concentrating SVF
The SVF was then concentrated by a standard bench top centrifuge.
Step 4 : Activation of SVF
The concentrated SVF was subsequently activated by the activation component, which was formulated to assist the cells to shift from a dormant state to an active state.
Step 5 : Injection of SVF
The activated SVF was injected superficially into selected area.
|
Clinical Trials
This approach is easy to performed, not too expensive, should hold a promise for the future. A joint study was performed in 2008-2009 which our doctor has participated. 5 patients including 4 male and one female patients with hair loss received SVF injection.
No improve hair re-growth was observed in all patients after 8 months. Stem cells have the potential to turn into a wide variety of body cells. We believed that the activation component of the supplied kit failed to trigger the differentiation of SVF into the desired hair follicle tissue. The company is in the process of refining the kit before the study is repeated.
|
 |
|
|
|
|
