There is new hope for treating hair loss – for women, too

She calls him Rapunzel, and for good reason: Angela Christiano is working on growing a full head of hair in the lab.

Christiano, a researcher at Columbia University, has a condition known as alopecia areata, which leads to sudden and substantial loss of hair. And she is not satisfied with the treatments on the market: there are only two drugs approved for hair loss, and both are over 20 years old.

So he’s trying a radically new approach: to turn a patient’s own stem cells, which in theory can become any type of body cell, into hair that could be transplanted to cover bald patches.

Christiano’s work – she also has a second start, taking a completely different direction – reflects a growing interest in the biotechnology community in treating hair loss as a medical condition. The problem has traditionally been treated as a cosmetic problem, so it is called less attention than terrible diseases like cancer. But scientists are now tackling the problem in a number of novel ways – though experts warn that fake beginnings are inevitable and it will be some time before new products hit the market.

“Hair is hot right now,” said Dr. Melissa Piliang, a dermatologist at the Cleveland Clinic. “But it’s hard to grow hair.”

Several forms of hair loss impact both men and women. The most immediately devastating type is alopecia areata – a rare condition in which the immune system attacks the hair follicles, causing huge strands of hair to fall into mass. Another is androgenetic alopecia – a genetic form of hair loss seen in both men and women, often from a relatively young age.

Then there is hair loss from aging, which also affects both genders. Half of all women experience some form of hair loss, especially after menopause, and can cause great agitation. “Women feel they should not lose their hair, and they have a tremendous amount of emotional anxiety about it,” Piliang said.

The two medications for hair loss on the market now are Propecia and Rogaine, or minoxidil, which is the only approved treatment for women, and which now comes in purple and teal packs marketed for women. (Propecia alters hormone levels so powerfully that pregnant women are advised not to even touch the pills). Since Americans spend $ 3.5 billion a year on hair loss products – most of which do not work at all – there is a huge financial incentive to develop something new.

So what’s going on?

Samumed, a San Diego startup who launched this year’s light with ambitious claims that he is inventing drugs to reverse aging, is working on baldness as well as diseases such as osteoarthritis and pancreatic cancer. Samumed approach is directed to a molecular signaling channel known as the WNT pathway, which plays an important role in hair growth. The company says it does not interfere with hormones – a major concern in the development of hair growth products for women.

The company has already conducted two phase 2 trials for male pattern baldness. In a trial of more than 300 patients, participants taking a low dose of the drug showed a nearly 10 percent increase in hair counts for 135 days. Those who took placebos continued to lose hair. The study has not been published or peer reviewed; The company presented the results this spring at a meeting of the American Academy of Dermatology.

So far, the drug has only been tried on men; testing the drug in women is part of Samumed’s “long-term plan,” but the company has to discuss it first with the Food and Drug Administration, said Dr. Yusuf Yazici, Samumed’s medical director. “Androgenetic alopecia is a bigger disease in men – more patients are affected by it,” he said.

Growing rat hair “as if it were not tomorrow”

Christiano is taking a different approach – or, in fact, two different approaches.

Its start-up Vixen Pharmaceuticals worked to develop a hair loss medication for the so-called JAK inhibitors, which rammed the activity of a class of enzymes called janus kinase. Two JAK inhibitors have been approved by the FDA – not for baldness, but for rheumatoid arthritis, psoriasis, and a type of skin cancer called myelofibrosis. Both are used off-label for other autoimmune conditions – including hair loss.

Vixen was acquired a few months ago by Aclaris Therapeutics, based in Pennsylvania; The company intends to develop JAK inhibitors to treat hair loss. (As for that name: “Vixen”, of course, is the term for female fox – and, as Christiano pointed out, the word “alopecia” means “mangy fox” in Greek.)

With her second boot, Rapunzel, Christiano aims to solve a major problem in hair transplant surgery: It requires removing hair from one part of the body to transplant it elsewhere. But there is only a finite amount of hair to harvest from one’s own body.

That’s why you want to grow hair in the laboratory.

The challenge to date has been to get stem cells from the scalp to turn into true hair follicles. For years, scientists could only transform them into standard fibroblasts, which are cells that create generic connective tissue. Christiano’s lab has now found that real hair can grow on a three-dimensional scaffold of tissue culture medium submerged with a mixture of growth factors.

“Rat hair, that is – we can grow rat hair like it’s not tomorrow,” Christiano said. “But we think we can do it with human hair, too.”

Hair restoration surgeon Dr. Joseph Greco believes that Christiano is heading in the right direction.

“The race to the moon is hair multiplication,” Greco said. “To be able to have an inexhaustible supply … That comes in the next five to 10 years.”

In addition to standard hair transplant surgery, Greco offers a technique called “platelet rich plasma,” or PRP, which is meant to stimulate the growth of lazy hair follicles. Seven out of 10 of her hair loss clients are women.

Greco’s team draws blood from a patient, centrifuge it in a centrifuge to extract the plasma, isolate platelet growth factors, add nutrients and then re-inject the mixture into patients’ scalp. It costs about $ 1,600 for the first treatment, then a little less for follow-up visits – recommended every six months to a year.

Greco participated in a 2014 pilot study of 64 women who found PRP promised in the treatment of androgenetic hair loss, but the procedure has not been formally tested in a randomized clinical trial.

Do not expect a miracle cure

For all the excitement surrounding the new approaches, scientists also raise a note of caution. They remember the enthusiasm more than a decade ago when a new gene was discovered that controls what is known as the “sonic hedgehog” route and was promising in the treatment of hair loss. New companies began to emerge around the hedgehog approach – until it hit a major hook.

“They discovered that the ‘Sonic The Hedgehog’ road was also involved in skin cancer – so that dampened the enthusiasm of using drugs for hair growth,” Christiano said.

Lauren Engle, a mother of two from Dallas, is not expecting a miracle cure. When she was pregnant with her first child, Engle “lost a ton of hair,” she said. She has tried Rogaine and spironolactone, which is used off the label for hair loss, but she got rid of the drugs because of her potential damage during her procreative years.

Engle writes a blog, “Corner of Hope and Mane,” and sends a regular newsletter to about 3,500 women, providing tips on how to “use hair”, and addressing the stigma and depression associated with hair loss. women.

“It’s devastating to many people,” Engle said. “Hair can be the crowning jewel of feminine appearance – of its feminine identity.”